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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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Adams | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Allen | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Bartholomew | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Benton | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Blackford | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Boone | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Brown | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Carroll | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Cass | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Clark | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Clay | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Clinton | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Crawford | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Daviess | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
De Kalb | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Dearborn | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Decatur | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Delaware | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Dubois | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Elkhart | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Fayette | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Floyd | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Fountain | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Franklin | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Fulton | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Gibson | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Grant | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Greene | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Hamilton | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Hancock | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Harrison | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Hendricks | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Henry | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Howard | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Huntington | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Jackson | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Jasper | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Jay | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Jefferson | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Jennings | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Johnson | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Knox | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Kosciusko | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
La Porte | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Lagrange | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Lake | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Lawrence | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Madison | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Marion | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Marshall | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Martin | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Miami | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Monroe | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Montgomery | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Morgan | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Newton | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Noble | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Ohio | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Orange | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Owen | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Parke | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Perry | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Pike | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Porter | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Posey | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Pulaski | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Putnam | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Randolph | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Ripley | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Rush | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Scott | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Shelby | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Spencer | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
St. Joseph | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Starke | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Steuben | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Sullivan | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Switzerland | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Tippecanoe | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Tipton | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Union | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Vanderburgh | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Vermillion | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Vigo | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Wabash | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Warren | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Warrick | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Washington | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Wayne | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Wells | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
White | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in IN - R5826-008-0 Benefit Details |
Whitley | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Adair | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Allen | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Anderson | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Ballard | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Barren | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Bath | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Bell | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Boone | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Bourbon | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Boyd | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Boyle | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Bracken | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Breathitt | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Breckinridge | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Bullitt | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Butler | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Caldwell | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Calloway | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Campbell | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Carlisle | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Carroll | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Carter | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Casey | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Christian | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Clark | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Clay | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Clinton | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Crittenden | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Cumberland | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Daviess | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Edmonson | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Elliott | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Estill | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Fayette | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Fleming | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Floyd | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Franklin | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Fulton | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Gallatin | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Garrard | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Grant | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Graves | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Grayson | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Green | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Greenup | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Hancock | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Hardin | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Harlan | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Harrison | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Hart | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Henderson | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Henry | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Hickman | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Hopkins | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Jackson | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Jefferson | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Jessamine | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Johnson | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Kenton | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Knott | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Knox | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Larue | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Laurel | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Lawrence | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Lee | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Leslie | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Letcher | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Lewis | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Lincoln | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Livingston | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Logan | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Lyon | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Madison | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Magoffin | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Marion | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Marshall | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Martin | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Mason | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
McCracken | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
McCreary | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
McLean | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Meade | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Menifee | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Mercer | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Metcalfe | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Monroe | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Montgomery | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Morgan | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Muhlenberg | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Nelson | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Nicholas | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Ohio | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Oldham | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Owen | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
-- | |||||||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Owsley | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Pendleton | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Perry | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Pike | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Powell | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Pulaski | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Robertson | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Rockcastle | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Rowan | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Russell | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Scott | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Shelby | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Simpson | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Spencer | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Taylor | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Todd | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Trigg | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Trimble | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Union | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Warren | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Washington | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Wayne | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Webster | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Whitley | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 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 | |||||||||
HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Wolfe | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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HumanaChoice R5826-008 (Regional PPO) in KY - R5826-008-0 Benefit Details |
Woodford | $71.00 | $200 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $60.00 Tier 4: 28% | $6,700 Browse Formulary | |||||
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