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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UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Aitkin | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Anoka | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Becker | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 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 | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Beltrami | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Benton | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Big Stone | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Blue Earth | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Brown | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Carlton | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Carver | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Cass | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Chippewa | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Chisago | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Clay | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Clearwater | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 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 | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Cook | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Cottonwood | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Crow Wing | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 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 | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Dakota | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Dodge | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Douglas | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Faribault | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Fillmore | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Freeborn | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Goodhue | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Grant | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Hennepin | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Houston | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Hubbard | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Isanti | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Itasca | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Jackson | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Kanabec | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Kandiyohi | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Kittson | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Koochiching | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Lac qui Parle | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Lake | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Lake of the Woods | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Le Sueur | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Lincoln | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Lyon | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Mahnomen | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Marshall | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Martin | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
McLeod | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Meeker | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Mille Lacs | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Morrison | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Mower | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Murray | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Nicollet | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Nobles | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Norman | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Olmsted | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Otter Tail | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Pennington | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Pine | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Pipestone | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Polk | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Pope | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Ramsey | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Red Lake | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Redwood | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Renville | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Rice | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Rock | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Roseau | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Scott | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Sherburne | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Sibley | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
St. Louis | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Stearns | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Steele | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Stevens | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Swift | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Todd | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Traverse | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Wabasha | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Wadena | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Waseca | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 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 | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Washington | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Watonwan | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Wilkin | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Winona | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Wright | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
UCare for Seniors Standard D (HMO-POS) in MN - H2459-018-0 Benefit Details |
Yellow Medicine | $55.00 | $325 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% | $3,400 Browse Formulary | |||||
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