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 Basic with Standard Rx - WI (Cost) in WI - H2450-008-0 Benefit Details |
Ashland | $122.30 | $0 | 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% | $3,000 Browse Formulary | |||||
Medica Prime Solution Basic with Standard Rx - WI (Cost) in WI - H2450-008-0 Benefit Details |
Barron | $122.30 | $0 | 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% | $3,000 Browse Formulary | |||||
Medica Prime Solution Basic with Standard Rx - WI (Cost) in WI - H2450-008-0 Benefit Details |
Bayfield | $122.30 | $0 | 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% | $3,000 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 Basic with Standard Rx - WI (Cost) in WI - H2450-008-0 Benefit Details |
Burnett | $122.30 | $0 | 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% | $3,000 Browse Formulary | |||||
Medica Prime Solution Basic with Standard Rx - WI (Cost) in WI - H2450-008-0 Benefit Details |
Chippewa | $122.30 | $0 | 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% | $3,000 Browse Formulary | |||||
Medica Prime Solution Basic with Standard Rx - WI (Cost) in WI - H2450-008-0 Benefit Details |
Douglas | $122.30 | $0 | 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% | $3,000 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 Basic with Standard Rx - WI (Cost) in WI - H2450-008-0 Benefit Details |
Dunn | $122.30 | $0 | 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% | $3,000 Browse Formulary | |||||
Medica Prime Solution Basic with Standard Rx - WI (Cost) in WI - H2450-008-0 Benefit Details |
Eau Claire | $122.30 | $0 | 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% | $3,000 Browse Formulary | |||||
Medica Prime Solution Basic with Standard Rx - WI (Cost) in WI - H2450-008-0 Benefit Details |
Pierce | $122.30 | $0 | 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% | $3,000 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 Basic with Standard Rx - WI (Cost) in WI - H2450-008-0 Benefit Details |
Polk | $122.30 | $0 | 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% | $3,000 Browse Formulary | |||||
Medica Prime Solution Basic with Standard Rx - WI (Cost) in WI - H2450-008-0 Benefit Details |
Sawyer | $122.30 | $0 | 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% | $3,000 Browse Formulary | |||||
Medica Prime Solution Basic with Standard Rx - WI (Cost) in WI - H2450-008-0 Benefit Details |
St. Croix | $122.30 | $0 | 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% | $3,000 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 Basic with Standard Rx - WI (Cost) in WI - H2450-008-0 Benefit Details |
Washburn | $122.30 | $0 | 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% | $3,000 Browse Formulary | |||||
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