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 TN - H5698-156-0 Benefit Details |
Anderson | $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 TN - H5698-156-0 Benefit Details |
Bedford | $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 TN - H5698-156-0 Benefit Details |
Bledsoe | $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 TN - H5698-156-0 Benefit Details |
Blount | $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 TN - H5698-156-0 Benefit Details |
Bradley | $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 TN - H5698-156-0 Benefit Details |
Campbell | $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 TN - H5698-156-0 Benefit Details |
Cannon | $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 TN - H5698-156-0 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 | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in TN - H5698-156-0 Benefit Details |
Cheatham | $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 TN - H5698-156-0 Benefit Details |
Chester | $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 TN - H5698-156-0 Benefit Details |
Claiborne | $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 TN - H5698-156-0 Benefit Details |
Cocke | $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 TN - H5698-156-0 Benefit Details |
Coffee | $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 TN - H5698-156-0 Benefit Details |
Crockett | $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 TN - H5698-156-0 Benefit Details |
Davidson | $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 TN - H5698-156-0 Benefit Details |
Decatur | $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 TN - H5698-156-0 Benefit Details |
DeKalb | $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 TN - H5698-156-0 Benefit Details |
Dyer | $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 TN - H5698-156-0 Benefit Details |
Fayette | $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 TN - H5698-156-0 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 | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in TN - H5698-156-0 Benefit Details |
Giles | $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 TN - H5698-156-0 Benefit Details |
Grainger | $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 TN - H5698-156-0 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 TN - H5698-156-0 Benefit Details |
Grundy | $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 TN - H5698-156-0 Benefit Details |
Hamblen | $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 TN - H5698-156-0 Benefit Details |
Hamilton | $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 TN - H5698-156-0 Benefit Details |
Hancock | $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 TN - H5698-156-0 Benefit Details |
Hardin | $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 TN - H5698-156-0 Benefit Details |
Hawkins | $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 TN - H5698-156-0 Benefit Details |
Haywood | $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 TN - H5698-156-0 Benefit Details |
Henderson | $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 TN - H5698-156-0 Benefit Details |
Henry | $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 TN - H5698-156-0 Benefit Details |
Hickman | $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 TN - H5698-156-0 Benefit Details |
Houston | $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 TN - H5698-156-0 Benefit Details |
Humphreys | $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 TN - H5698-156-0 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 | |||||
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 TN - H5698-156-0 Benefit Details |
Jefferson | $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 TN - H5698-156-0 Benefit Details |
Knox | $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 TN - H5698-156-0 Benefit Details |
Lake | $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 TN - H5698-156-0 Benefit Details |
Lauderdale | $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 TN - H5698-156-0 Benefit Details |
Lawrence | $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 TN - H5698-156-0 Benefit Details |
Lewis | $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 TN - H5698-156-0 Benefit Details |
Loudon | $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 TN - H5698-156-0 Benefit Details |
Macon | $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 TN - H5698-156-0 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 | |||||
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 TN - H5698-156-0 Benefit Details |
Marshall | $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 TN - H5698-156-0 Benefit Details |
Maury | $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 TN - H5698-156-0 Benefit Details |
McMinn | $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 TN - H5698-156-0 Benefit Details |
McNairy | $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 TN - H5698-156-0 Benefit Details |
Meigs | $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 TN - H5698-156-0 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 | |||||
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 TN - H5698-156-0 Benefit Details |
Moore | $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 TN - H5698-156-0 Benefit Details |
Obion | $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 TN - H5698-156-0 Benefit Details |
Overton | $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 TN - H5698-156-0 Benefit Details |
Pickett | $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 TN - H5698-156-0 Benefit Details |
Polk | $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 TN - H5698-156-0 Benefit Details |
Rhea | $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 TN - H5698-156-0 Benefit Details |
Roane | $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 TN - H5698-156-0 Benefit Details |
Rutherford | $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 TN - H5698-156-0 Benefit Details |
Scott | $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 TN - H5698-156-0 Benefit Details |
Sequatchie | $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 TN - H5698-156-0 Benefit Details |
Sevier | $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 TN - H5698-156-0 Benefit Details |
Shelby | $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 TN - H5698-156-0 Benefit Details |
Smith | $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 TN - H5698-156-0 Benefit Details |
Stewart | $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 TN - H5698-156-0 Benefit Details |
Sullivan | $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 TN - H5698-156-0 Benefit Details |
Sumner | $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 TN - H5698-156-0 Benefit Details |
Tipton | $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 TN - H5698-156-0 Benefit Details |
Trousdale | $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 TN - H5698-156-0 Benefit Details |
Unicoi | $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 TN - H5698-156-0 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 | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in TN - H5698-156-0 Benefit Details |
Van Buren | $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 |
|||||
Service | Exper. | Cost Info | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in TN - H5698-156-0 Benefit Details |
Wayne | $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 TN - H5698-156-0 Benefit Details |
Weakley | $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 TN - H5698-156-0 Benefit Details |
Williamson | $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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