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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Aitkin | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Anoka | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Becker | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Beltrami | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Benton | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Big Stone | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Blue Earth | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Brown | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Carlton | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Carver | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Cass | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Chippewa | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Chisago | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Clay | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Clearwater | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Cook | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Cottonwood | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Crow Wing | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Dakota | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Dodge | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Douglas | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Faribault | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Fillmore | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Freeborn | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Goodhue | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Grant | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Hennepin | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Houston | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Hubbard | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Isanti | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Itasca | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Jackson | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Kanabec | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Kandiyohi | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Kittson | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Koochiching | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Lac qui Parle | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Lake | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Lake of the Woods | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Le Sueur | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Lincoln | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Lyon | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Mahnomen | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Marshall | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Martin | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
McLeod | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Meeker | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Mille Lacs | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Morrison | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Mower | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Murray | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Nicollet | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Nobles | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Norman | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Olmsted | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Otter Tail | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Pennington | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Pine | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Pipestone | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Polk | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Pope | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Ramsey | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Red Lake | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Redwood | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Renville | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Rice | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Rock | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Roseau | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Scott | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Sherburne | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Sibley | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
St. Louis | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Stearns | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Steele | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Stevens | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Swift | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Todd | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Traverse | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Wabasha | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Wadena | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Waseca | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Washington | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Watonwan | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Wilkin | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 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 Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Winona | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Wright | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
Medica Prime Solution Enhanced with Thrift Rx - MN (Cost) in MN - H2450-017-0 Benefit Details |
Yellow Medicine | $161.50 | $180 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $10.00 Non-Preferred Generic and Preferred Brand Drugs: $34.00 Specialty Tier Drugs: 25% | $3,000 Browse Formulary | |||||
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