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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Adams | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Alexander | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Bond | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Boone | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Brown | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Bureau | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Calhoun | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Carroll | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Cass | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Champaign | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Christian | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Clark | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Clay | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Clinton | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Coles | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Cook | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Crawford | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Cumberland | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
De Witt | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
DeKalb | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Douglas | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
DuPage | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Edgar | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Edwards | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Effingham | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Fayette | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Ford | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Franklin | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Fulton | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Gallatin | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Greene | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Grundy | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Hamilton | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Hancock | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Hardin | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Henderson | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Henry | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Iroquois | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Jackson | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Jasper | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Jefferson | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Jersey | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Jo Daviess | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Johnson | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Kane | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Kankakee | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Kendall | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Knox | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
La Salle | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Lake | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Lawrence | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Lee | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Livingston | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Logan | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Macon | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Macoupin | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Madison | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Marion | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Marshall | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Mason | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Massac | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
McDonough | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
McHenry | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
McLean | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Menard | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Mercer | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Monroe | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Montgomery | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Morgan | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Moultrie | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Ogle | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Peoria | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Perry | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Piatt | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Pike | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Pope | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Pulaski | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Putnam | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Randolph | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Richland | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Rock Island | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Saline | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Sangamon | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Schuyler | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Scott | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Shelby | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
St. Clair | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Stark | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Stephenson | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Tazewell | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Union | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Vermilion | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Wabash | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Warren | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Washington | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Wayne | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
White | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Whiteside | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Will | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Williamson | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Winnebago | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in IL - R5826-009-0 Benefit Details |
Woodford | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Adams | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Ashland | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Barron | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Bayfield | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Brown | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Buffalo | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Burnett | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Calumet | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Chippewa | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Clark | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Columbia | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Crawford | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Dane | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Dodge | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Door | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Douglas | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Dunn | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Eau Claire | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Florence | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Fond du Lac | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Forest | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Grant | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Green | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Green Lake | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Iowa | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Iron | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Jackson | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Jefferson | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Juneau | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Kenosha | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Kewaunee | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
La Crosse | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Lafayette | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Langlade | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Lincoln | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Manitowoc | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Marathon | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Marinette | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Marquette | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Menominee | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Milwaukee | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Monroe | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Oconto | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Oneida | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Outagamie | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Ozaukee | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Pepin | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Pierce | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Polk | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Portage | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Price | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Racine | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Richland | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Rock | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Rusk | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Sauk | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Sawyer | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Shawano | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Sheboygan | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
St. Croix | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Taylor | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Trempealeau | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Vernon | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Vilas | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Walworth | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Washburn | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Washington | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Waukesha | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Waupaca | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 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 R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Waushara | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Winnebago | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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HumanaChoice R5826-009 (Regional PPO) in WI - R5826-009-0 Benefit Details |
Wood | $67.00 | $320 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | $5,000 Browse Formulary | |||||
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