2012 Medicare Part D Contract ID/Plan ID Search

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2012 Medicare Part D Contract ID/Plan ID Search

This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

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Review 2012 Medicare Advantage plans

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**There are 201 2012 Medicare Advantage plans (MAPD) meeting your criteria.**
2012 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips
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	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
Humana Gold Choice H2944-013 (PFFS) in AR - H2944-013-0 Benefit Details			Bradley	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in AR - H2944-013-0 Benefit Details			Chicot	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in AR - H2944-013-0 Benefit Details			Columbia	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in AR - H2944-013-0 Benefit Details			Drew	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in AR - H2944-013-0 Benefit Details			Hempstead	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in AR - H2944-013-0 Benefit Details			Little River	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in AR - H2944-013-0 Benefit Details			Nevada	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in AR - H2944-013-0 Benefit Details			Sevier	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in CO - H2944-013-0 Benefit Details			Baca	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Allen	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Atchison	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Barber	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Barton	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Brown	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Chase	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Chautauqua	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Cheyenne	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Clark	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Clay	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Cloud	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Coffey	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Comanche	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Cowley	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Decatur	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Dickinson	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Doniphan	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Edwards	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Elk	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Ellis	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Ellsworth	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Finney	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Ford	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Franklin	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Geary	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Gove	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Graham	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Grant	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Gray	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Greeley	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Greenwood	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Hamilton	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Harper	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Haskell	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Hodgeman	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Jackson	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Jefferson	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Jewell	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Kearny	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Kingman	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Kiowa	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Lane	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Lincoln	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Logan	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Lyon	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Marion	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Marshall	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			McPherson	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Meade	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Mitchell	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Montgomery	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Morris	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Morton	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Nemaha	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Neosho	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Ness	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Norton	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Osage	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Osborne	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Ottawa	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Pawnee	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Phillips	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Pottawatomie	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Pratt	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Rawlins	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Reno	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Republic	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Rice	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Riley	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Rooks	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Rush	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Russell	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Saline	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Scott	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Seward	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Sheridan	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Sherman	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Smith	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Stafford	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Stanton	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Stevens	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Sumner	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Thomas	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Trego	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Wabaunsee	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Wallace	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Washington	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Wichita	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Wilson	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0 Benefit Details			Woodson	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Adair	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Andrew	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Atchison	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Audrain	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Bates	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Bollinger	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Buchanan	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Butler	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Caldwell	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Camden	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Cape Girardeau	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Carter	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Chariton	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Clark	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Cooper	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Daviess	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			DeKalb	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Dent	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Dunklin	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Gentry	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Grundy	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Harrison	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Holt	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Howard	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Howell	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Iron	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Knox	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Lewis	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Linn	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Macon	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Madison	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Maries	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Marion	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Mercer	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Mississippi	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Monroe	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Morgan	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			New Madrid	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Nodaway	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Oregon	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Pettis	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Putnam	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Ralls	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Randolph	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Reynolds	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Ripley	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Schuyler	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Scotland	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Scott	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Shannon	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Shelby	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			St. Francois	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Stoddard	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Sullivan	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Texas	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Vernon	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Wayne	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0 Benefit Details			Worth	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Alfalfa	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Atoka	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Beaver	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Beckham	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Blaine	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Bryan	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Carter	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Cherokee	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Choctaw	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Cimarron	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Coal	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Comanche	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Cotton	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Custer	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Dewey	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Ellis	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Garfield	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Grant	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Greer	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Harmon	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Harper	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Hughes	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Jackson	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Jefferson	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Johnston	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Kay	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Kiowa	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Latimer	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Love	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Major	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			McCurtain	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Noble	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Nowata	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Okfuskee	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Pittsburg	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Pontotoc	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Pushmataha	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Roger Mills	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Stephens	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Texas	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Tillman	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Washita	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Woods	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0 Benefit Details			Woodward	$69.00	$0	Few Generics, Few Brands	Tier 1: $7.00 Tier 2: $40.00 Tier 3: $80.00 Tier 4: 33%	$5,000 Browse Formulary

Review 2012 Medicare Advantage plans

Chart Legend:

Below are a few notes to help with the understanding of the 2012 Medicare Part D Prescription Drug Plan chart above and Search Tips to help you narrow down your list of plans to those that best meet your needs.

A few notes to help with the understanding of the 2012 Medicare Part D Prescription Drug Plan chart above and Search Tips to help you narrow down your list of plans to those that best meet your needs.

Plan Name: This is the official plan name from the Centers for Medicare and Medicaid Services (CMS). The same plan name generally has a different plan id in each state. (Search Tip: If you would like to reduce the plans shown to just plans for one or two specific carriers, you can select the carrier name in the "Plan Family" fields 1 and 2. Select the empty (blank) option at the top of the list to remove the criteria. You can also click the "National Plans" checkbox to limit your search to just national plans.)

CMS Plan Ratings: these are found under the Plan Name at the left side of the chart.

This is a 1 to 5 star rating system with five (5) stars as excellent, four (4) stars as very good, three (3) stars as good, two (2) stars as fair and one (1) star as poor.

Cust. Service Rating - Drug Plan Customer Service - Medicare and members rate the drug plan and how well a drug plan provides customer service.

This category includes measures of how drug plans rate on the following areas:
- Time on Hold When Customer and Pharmacist Calls Drug Plan.
- Calls Disconnected When Customer and Pharmacist Calls Drug Plan.
- Drug Plan’s Timeliness in Giving a Decision for Members Who Make an Appeal.
- Fairness of Drug Plan’s Denials to a Member’s Appeal, Based on an Independent Reviewer.

Member Plan Exper. - Member Experience with Drug Plan - This category shows how well drug plans make prescription drugs available to their members.

This category includes measures of how drug plans rate on the following areas:
- Drug Plan Provides Information or Help When Members Need It.
- Members’ Overall Rating of Drug Plan.
- Members’ Ability to Get Prescriptions Filled Easily When Using the Drug Plan.

RxCost Info Rating - This category shows how well drug plans are doing with pricing prescriptions and providing information on the Medicare website.

This category includes measures of how drug plans rate on the following areas:
- Completeness of the Drug Plan’s Information on Members Who Need Extra Help.
- Drug Plan Provides Current Information on Costs and Coverage for Medicare’s Website (the same data is used on this Q1Medicare.com).
- Drug Plan’s Prices that Did Not Increase More Than Expected During the Year.
- Drug Plan’s Prices on Medicare’s Website (and this website) Are Similar to the Prices Members Pay at the Pharmacy.
- Drug Plan’s Members 65 and Older Who Received Prescriptions for Certain Drugs with a High Risk of Side Effects, when There May Be Safer Drug Choices.

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Monthly Premium: This is the amount you must pay each month to use the plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase. (Search Tip: If you would like to reduce the plans shown to just plans under a certain premium, enter this value in the "Maximum Premium" field.)
Deductible: This is the $320 deductible that was presented in the CMS Standard Plan. Many provider’s plans do not have a deductible, however the premium may be higher. (Search Tip: If you would like to reduce the plans shown to just plans with a deductible under a certain value, enter this value in the "Maximum Deductible field" field.)
Gap Coverage: the Donut Hole: In the CMS Standard Plan, the beneficiary must pay the next $3727.5 in drug costs (the Donut Hole). The Healthcare Reform provides that for Plan Year 2012, ALL formulary generics will have at least a 14% discount and ALL brand drugs will have at least a 50% discount in the coverage gap. The Gap Coverage Types discussed in this section are in addition to the Healthcare Reform mandated discounts. In our chart, you will see one of the following:
- No Gap Coverage: you must pay the $3727.5;
- Few Generics: less than 10% of formulary generics are covered, but you must pay for Brand Drugs up to $3727.5;
- Some Generics: 10% to 65% of formulary generics are covered, but you must pay for Brand Drugs up to $3727.5;
- Many Generics: 65% to 100% of formulary generics are covered, but you must pay for Brand Drugs up to $3727.5;
- All Generics : All formulary Generics are covered, but you must pay for Brand Drugs up to $3727.5;
- Many Generics & Some Brands: These Medicare prescription drug plans cover 65% to 100% of formulary generics and a some (10% to 65%) of Brand drugs on the plan’s formulary.
- Some Generics & Some Brands: These Medicare prescription drug plans cover 10% to 65% of Generic and Brand drugs on the plan’s formulary. (Search Tip: If you would like to reduce the plans shown to just plans with a certain type of gap coverage, select this type of coverage in the "Type of Gap Coverage" field.)
$0 Premium with Full LIS - Does the plan Qualify for $0 Premium with Full Low-Income Subsidy?: If Yes is in the field, then you would pay a $0 premium if you have a Full Low-Income Subsidy (LIS). If No is in the field, then you would be responsible for the difference between what the state provides as the Full Low-Income Subsidy and the actual cost of the plan even if you have a Full Low-Income Subsidy. (Search Tip: If you would like to reduce the plans shown to just plans that qualify for the $0 premium (Benchmark plans), select "Yes..." in the "Full Low-Income Subsidy?" field.)
Plan ID: This is the unique id for this particular plan.

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Copay / Coinsurance - Cost Sharing - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. Plans can form their own tiers, so you should contact the plan or reference their summary of benefits to find out what copays and limitations are associated with each tier. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. (Search Tip: If you would like to reduce the plans shown to just plans that have a tier 1 (Generics) co-pay of up to a certain value (ex: $0 co-pay), enter the value (ex: 0) in the "Max. Co-pay Tier 1 (Generics)" field.)

Additional Information Fields:
You can select one of the following additional pieces of plan information to display (Search Tip: to change the type of information shown in the last column of the chart, select the data to be shown in the "Additional Info" field.)

Total Formulary Drugs (default) - This is the total number of medications on the plans formulary or drug list. For 2009 Medicare Part D plans, the smallest formulary is the Geisinger Gold Rx 1 plan formulary in PA and WV with 1,994 total medications and the largest formulary is the AARP Enhanced and Preferred plans’ formulary (all states) with 5,218 total formulary drugs. This total drug count does not include "Bonus Drugs". These are non-Medicare Part D drugs which are covered by the plan, however they do not count toward your plan deductible, retail drug cost, or TrOOP.
Offers Mail Order - "Yes" is displayed if this plan offers mail order on any medications. It does NOT mean that ALL medications are available through mail order.
Members in This State (updated: December 2012 figures) - This is the total number of members in this plan for this CMS Region. For regions which contain more than one state, this is the total for all of those states combined. We are showing the latest Medicare Part D plan enrollment figures. We update this figure as new enrollment statistics are released by Medicare.
Members Nation Wide (updated: December 2012 figures) - This is the total number of member for this plan in all CMS Regions (States) combined. We are showing the latest Medicare Part D plan enrollment figures. We update this figure as new enrollment statistics are released by Medicare.

Initial Coverage Limit (ICL) - The initial coverage limit phase of a Medicare Part D plan is the phase AFTER the initial deductible is met (if the plan has an initial deductible) and BEFORE the coverage gap (or donut hole) begins. The ICL is the phase of the prescription drug plan during which you and your plan share your prescription costs. During this phase you will pay either a co-payment (a flat fee per prescription) or co-insurance (a percentage of the drug cost). The details of the cost-sharing for the plan are shown in the Cost-Sharing column directly to the left of this column. The CMS standard Initial Coverage Limit for 2012 is $2930 and increases each year.
National or Regional Plans - This column simply displays the word "National" if the plan is sponsored by a national carrier or "Regional" if the plan sponsor is a regional carrier.

(Chart Source: various files provided by the Centers for Medicare and Medicaid Services along with data from the Medicare.gov website plan finder.)

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, we cannot guarantee the accuracy of this information.

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