2012 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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HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Adjuntas | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Aguada | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Aguadilla | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Aguas Buenas | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Aibonito | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Anasco | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Arecibo | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Arroyo | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Barceloneta | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Barranquitas | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Bayamon | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Cabo Rojo | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Caguas | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Camuy | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Canovanas | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Carolina | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Catano | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Cayey | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Ceiba | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Ciales | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Cidra | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Coamo | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Comerio | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Corozal | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Culebra | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Dorado | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Fajardo | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Florida | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Guanica | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Guayama | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Guayanilla | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Guaynabo | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Gurabo | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Hatillo | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Hormigueros | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Humacao | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Isabela | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Jayuya | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Juana Diaz | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Juncos | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Lajas | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Lares | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Las Marias | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Las Piedras | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Loiza | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Luquillo | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Manati | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Maricao | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Maunabo | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Mayaguez | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Moca | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Morovis | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Naguabo | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Naranjito | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Orocovis | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Patillas | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Penuelas | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Ponce | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Quebradillas | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Rincon | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Rio Grande | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Sabana Grande | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Salinas | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
San German | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
San Juan | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
San Lorenzo | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
San Sebastian | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Santa Isabel | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Toa Alta | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Toa Baja | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Trujillo Alto | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Utuado | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 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 | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Vega Alta | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Vega Baja | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Vieques | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Villalba | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Yabucoa | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
HumanaChoice H2029-002 (PPO) in PR - H2029-002-0 Benefit Details |
Yauco | $79.00 | $0 | Some Generics, Few Brands | Tier 1: $3.00 Tier 2: $30.00 Tier 3: $68.00 Tier 4: 33% | $3,400 Browse Formulary | |||||
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