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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FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Barbour | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Brooke | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Fayette | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Greenbrier | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Hampshire | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Hancock | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Harrison | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Marion | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Marshall | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
McDowell | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Mercer | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Mineral | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Monongalia | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Monroe | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Morgan | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Pleasants | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Pocahontas | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Preston | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Raleigh | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Randolph | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Summers | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Taylor | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Tyler | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Webster | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Wetzel | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Wood | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) in WV - H5106-015-0 Benefit Details |
Wyoming | $147.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $10.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 33% | $4,000 Browse Formulary | |||||
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