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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Aitkin | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Anoka | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Becker | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Beltrami | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Benton | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Big Stone | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Blue Earth | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Brown | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Carlton | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Carver | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Cass | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Chippewa | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Chisago | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Clay | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Clearwater | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Cook | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Cottonwood | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Crow Wing | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Dakota | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Dodge | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Douglas | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Faribault | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Fillmore | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Freeborn | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Goodhue | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Grant | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Hennepin | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Houston | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Hubbard | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Isanti | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Itasca | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Jackson | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Kanabec | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Kandiyohi | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Kittson | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Koochiching | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Lac qui Parle | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Lake | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Lake of the Woods | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Le Sueur | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Lincoln | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Lyon | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Mahnomen | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Marshall | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Martin | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
McLeod | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Meeker | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Mille Lacs | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Morrison | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Mower | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Murray | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Nicollet | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Nobles | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Norman | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Olmsted | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Otter Tail | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Pennington | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Pine | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Pipestone | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Polk | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Pope | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Ramsey | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Red Lake | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Redwood | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Renville | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Rice | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Rock | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Roseau | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Scott | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Sherburne | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Sibley | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
St. Louis | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Stearns | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Steele | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Stevens | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Swift | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Todd | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Traverse | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Wabasha | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Wadena | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Waseca | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Washington | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Watonwan | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Wilkin | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Winona | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Wright | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in MN - H2450-007-0 Benefit Details |
Yellow Medicine | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Adams | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Barnes | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Bowman | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Burleigh | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Cass | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Cavalier | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Dickey | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Dunn | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Eddy | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Emmons | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Foster | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Grand Forks | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Grant | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Griggs | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Hettinger | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Kidder | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
LaMoure | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Logan | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
McHenry | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
McIntosh | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
McLean | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Mercer | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Morton | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Oliver | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Pembina | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Pierce | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Ransom | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Richland | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Sargent | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Sheridan | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Sioux | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Stark | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Steele | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Stutsman | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Traill | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Walsh | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in ND - H2450-007-0 Benefit Details |
Ward | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Aurora | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Beadle | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Bennett | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Bon Homme | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Brookings | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Brown | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Brule | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Buffalo | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Butte | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Campbell | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Charles Mix | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Clark | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Clay | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Codington | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Custer | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Davison | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Day | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Deuel | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Dewey | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Douglas | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Edmunds | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Fall River | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Grant | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Gregory | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Haakon | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Hamlin | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Hand | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Hanson | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Harding | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Hughes | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Hutchinson | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Jackson | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Jerauld | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Jones | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Kingsbury | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Lake | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Lawrence | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Lincoln | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Lyman | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Marshall | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
McCook | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
McPherson | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Meade | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Mellette | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Miner | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Minnehaha | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Moody | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Pennington | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Perkins | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Roberts | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Sanborn | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Shannon | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Spink | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Stanley | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Todd | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Tripp | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Turner | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Union | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Yankton | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in SD - H2450-007-0 Benefit Details |
Ziebach | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in WI - H2450-007-0 Benefit Details |
Ashland | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in WI - H2450-007-0 Benefit Details |
Barron | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in WI - H2450-007-0 Benefit Details |
Bayfield | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in WI - H2450-007-0 Benefit Details |
Burnett | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in WI - H2450-007-0 Benefit Details |
Chippewa | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in WI - H2450-007-0 Benefit Details |
Douglas | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in WI - H2450-007-0 Benefit Details |
Dunn | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in WI - H2450-007-0 Benefit Details |
Eau Claire | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in WI - H2450-007-0 Benefit Details |
Pierce | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in WI - H2450-007-0 Benefit Details |
Polk | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in WI - H2450-007-0 Benefit Details |
Sawyer | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 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 Prime Solution Value Thrift with Rx (Cost) in WI - H2450-007-0 Benefit Details |
St. Croix | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
Medica Prime Solution Value Thrift with Rx (Cost) in WI - H2450-007-0 Benefit Details |
Washburn | $61.50 | $185 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $5,000 Browse Formulary | |||||
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