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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Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Arkansas | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Ashley | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Baxter | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Benton | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Calhoun | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Carroll | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Clark | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Clay | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Cleburne | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Cleveland | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Conway | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Craighead | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Crawford | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Crittenden | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Cross | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Dallas | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Desha | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Franklin | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Fulton | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Garland | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Grant | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Greene | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Hot Spring | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Independence | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Jackson | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Johnson | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Lee | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Lincoln | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Logan | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Lonoke | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Madison | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Marion | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Mississippi | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Monroe | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Montgomery | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Newton | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Ouachita | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Perry | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Phillips | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Pike | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Poinsett | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Prairie | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Pulaski | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Randolph | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Saline | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Searcy | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Sebastian | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Sharp | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
St. Francis | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Stone | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Union | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Washington | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
White | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Woodruff | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in AR - H5698-154-0 Benefit Details |
Yell | $100.00 | $0 | Some Generics | Tier 1: $5.00 Tier 2: $10.00 Tier 3: $35.00 Tier 4: $60.00 Tier 5: 33% | n/a Browse Formulary | |||||
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