2012 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Adjuntas | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Aguada | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Aguadilla | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Aguas Buenas | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Aibonito | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Anasco | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Arecibo | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Arroyo | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Barceloneta | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Barranquitas | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Bayamon | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Cabo Rojo | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Caguas | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Camuy | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Canovanas | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Carolina | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Catano | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Cayey | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Ceiba | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Ciales | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Cidra | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Coamo | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Comerio | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Corozal | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Culebra | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Dorado | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Fajardo | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Florida | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Guanica | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Guayama | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Guayanilla | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Guaynabo | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Gurabo | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Hatillo | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Hormigueros | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Humacao | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Isabela | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Jayuya | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Juana Diaz | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Juncos | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Lajas | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Lares | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Las Marias | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Las Piedras | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Loiza | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Luquillo | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Manati | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Maricao | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Maunabo | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Mayaguez | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Moca | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Morovis | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Naguabo | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Naranjito | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Orocovis | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Patillas | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Penuelas | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Ponce | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Quebradillas | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Rincon | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Rio Grande | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Sabana Grande | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Salinas | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
San German | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
San Juan | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
San Lorenzo | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
San Sebastian | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Santa Isabel | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Toa Alta | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Toa Baja | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Trujillo Alto | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Utuado | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Vega Alta | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Vega Baja | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Vieques | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Villalba | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Yabucoa | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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Humana Gold Plus H4007-012 (HMO) in PR - H4007-012-0 Benefit Details ![]() ![]() ![]() ![]() |
Yauco | $0.00 | $0 | Few Generics | Tier 1: $0.00 Tier 2: $20.00 Tier 3: $40.00 | $3,500 Browse Formulary | |||||
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