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 HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Berkeley | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Boone | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Braxton | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 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 | |||||||||
FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Cabell | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Calhoun | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Clay | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 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 | |||||||||
FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Doddridge | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Gilmer | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Grant | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 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 | |||||||||
FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Hardy | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Jackson | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Jefferson | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 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 | |||||||||
FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Kanawha | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Lewis | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Lincoln | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 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 | |||||||||
FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Logan | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Mason | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Mingo | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 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 | |||||||||
FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Nicholas | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Ohio | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Pendleton | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 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 | |||||||||
FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Putnam | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Ritchie | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Roane | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 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 | |||||||||
FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Tucker | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Upshur | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Wayne | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 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 | |||||||||
FreedomBlue PPO HD (PPO) in WV - H5106-025-0 Benefit Details ![]() ![]() ![]() ![]() |
Wirt | $0.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $9.00 Tier 2: $45.00 Tier 3: $90.00 Tier 4: 29% | $2,850 Browse Formulary | |||||
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