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 |
|||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Anderson | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Bedford | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Benton | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Bledsoe | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Blount | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Bradley | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Campbell | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Cannon | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Carroll | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Cheatham | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Chester | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Claiborne | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Cocke | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Coffee | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Crockett | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Davidson | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Decatur | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
DeKalb | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Dyer | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Fayette | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Franklin | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Giles | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Grainger | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Greene | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Grundy | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Hamblen | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Hamilton | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Hancock | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Hardeman | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Hardin | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Hawkins | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Haywood | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Henderson | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Henry | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Hickman | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Houston | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Humphreys | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Jackson | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Jefferson | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Knox | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Lake | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Lauderdale | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Lawrence | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Lewis | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Loudon | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Macon | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Madison | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Marshall | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Maury | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
McMinn | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
McNairy | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Meigs | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Monroe | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Montgomery | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Moore | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Morgan | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Obion | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Overton | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Pickett | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Polk | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Rhea | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Roane | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Rutherford | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Scott | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Sequatchie | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Sevier | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Shelby | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Smith | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Stewart | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Sullivan | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Sumner | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Tipton | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Trousdale | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Unicoi | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Union | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Van Buren | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Wayne | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Weakley | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diamond Plan (HMO) in TN - H5698-068-0 Benefit Details |
Williamson | $145.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $39.00 Tier 4: $65.00 Tier 5: 33% | $3,400 Browse Formulary | |||||
|