2013 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Adams | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Alamosa | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Arapahoe | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Archuleta | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Bent | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Boulder | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Broomfield | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Chaffee | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Cheyenne | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Clear Creek | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Conejos | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Costilla | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Crowley | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Custer | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Delta | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Denver | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Dolores | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Douglas | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Eagle | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
El Paso | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Elbert | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Fremont | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Garfield | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Gilpin | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Grand | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Gunnison | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Hinsdale | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Huerfano | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Jackson | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Jefferson | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Kiowa | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Kit Carson | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
La Plata | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Lake | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Larimer | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Las Animas | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Lincoln | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Logan | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Mesa | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Mineral | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Moffat | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Montezuma | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Montrose | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Morgan | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Otero | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Ouray | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Park | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Phillips | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Pitkin | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Prowers | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Pueblo | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Rio Blanco | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Rio Grande | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Routt | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Saguache | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
San Juan | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
San Miguel | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Sedgwick | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Summit | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Teller | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 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 Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Washington | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Weld | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
Rocky Mountain Thrifty Plan + Rx (Cost) in CO - H0602-039-0 Benefit Details |
Yuma | $74.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% | $6,000 Browse Formulary | |||||
|