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 |
|||||||||
Humana Gold Choice H2944-204 (PFFS) in AR - H2944-204-0 Benefit Details |
Chicot | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in AR - H2944-204-0 Benefit Details |
Columbia | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in AR - H2944-204-0 Benefit Details |
Drew | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in AR - H2944-204-0 Benefit Details |
Hempstead | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in AR - H2944-204-0 Benefit Details |
Little River | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in AR - H2944-204-0 Benefit Details |
Nevada | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in AR - H2944-204-0 Benefit Details |
Sevier | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in CO - H2944-204-0 Benefit Details |
Baca | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Allen | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Atchison | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Barber | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Barton | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Brown | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Chase | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Chautauqua | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Cheyenne | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Clark | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Clay | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Cloud | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Coffey | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Comanche | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Decatur | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Dickinson | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Doniphan | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Edwards | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Elk | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Ellis | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Ellsworth | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Finney | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Ford | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Geary | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Gove | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Graham | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Grant | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Gray | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Greeley | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Greenwood | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Hamilton | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Harper | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Haskell | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Hodgeman | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Jackson | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Jefferson | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Jewell | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Kearny | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Kiowa | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Lane | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Lincoln | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Logan | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Lyon | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Marion | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Marshall | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
McPherson | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Meade | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Mitchell | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Montgomery | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Morris | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Morton | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Nemaha | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Neosho | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Ness | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Norton | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Osborne | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Ottawa | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Pawnee | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Phillips | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Pratt | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Rawlins | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Reno | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Republic | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Rice | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Riley | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Rooks | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Rush | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Russell | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Saline | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Scott | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Seward | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Sheridan | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Sherman | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Smith | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Stafford | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Stanton | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Stevens | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Thomas | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Trego | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Wallace | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Washington | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Wichita | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Wilson | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Woodson | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Adair | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Andrew | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Atchison | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Bollinger | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Buchanan | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Butler | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Caldwell | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Camden | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Cape Girardeau | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Carter | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Chariton | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Clark | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Cooper | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Daviess | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
DeKalb | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Dent | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Dunklin | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Gentry | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Grundy | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Holt | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Howard | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Iron | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Knox | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Lewis | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Linn | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Macon | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Madison | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Maries | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Marion | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Mercer | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Mississippi | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Morgan | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
New Madrid | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Nodaway | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Putnam | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Ralls | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Randolph | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Reynolds | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Ripley | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Schuyler | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Scotland | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Scott | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Shannon | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Shelby | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Stoddard | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Sullivan | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Texas | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Wayne | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Worth | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Alfalfa | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Atoka | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Beaver | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Beckham | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Blaine | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Bryan | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Cherokee | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Choctaw | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Cimarron | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Coal | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Custer | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Grant | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Harmon | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Harper | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Jackson | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Jefferson | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Johnston | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Latimer | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Love | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Major | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
McCurtain | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Noble | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Okfuskee | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Pontotoc | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Pushmataha | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Roger Mills | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Tillman | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Washita | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Woods | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Woodward | $49.00 | $320 | Few Generics, Few Brands | Tier 1: $1.00 Tier 2: $5.00 Tier 3: 20% Tier 4: 30% | $6,700 Browse Formulary | |||||
|