2013 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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Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Adams | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Alamosa | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Arapahoe | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Archuleta | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Bent | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Boulder | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Broomfield | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Chaffee | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Cheyenne | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Clear Creek | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Conejos | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Costilla | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Crowley | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Custer | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Delta | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Denver | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Dolores | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Douglas | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Eagle | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
El Paso | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Elbert | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Fremont | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Garfield | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Gilpin | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Grand | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Gunnison | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Hinsdale | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Huerfano | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Jackson | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Jefferson | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Kiowa | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Kit Carson | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
La Plata | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Lake | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Larimer | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Las Animas | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Lincoln | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Logan | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Mesa | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Mineral | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Moffat | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Montezuma | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Montrose | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Morgan | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Otero | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Ouray | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Park | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Phillips | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Pitkin | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Prowers | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Pueblo | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Rio Blanco | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Rio Grande | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Routt | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Saguache | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
San Juan | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
San Miguel | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Sedgwick | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Summit | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Teller | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Washington | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Weld | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Rocky Mountain Plus Plan + Rx (Cost) in CO - H0602-019-0 Benefit Details |
Yuma | $249.80 | $0 | All Generics | Preferred Generic: $3.00 Non-Preferred Generic: $9.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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