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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Humana Gold Choice H2944-204 (PFFS) in AR - H2944-204-0 Benefit Details |
Chicot | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in AR - H2944-204-0 Benefit Details |
Drew | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Allen | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Atchison | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Barber | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Barton | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Brown | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Chase | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Chautauqua | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Cheyenne | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Clark | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Clay | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Cloud | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Coffey | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Comanche | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Cowley | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Decatur | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Dickinson | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Doniphan | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Edwards | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Elk | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Ellis | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Ellsworth | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Finney | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Ford | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Franklin | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Geary | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Gove | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Graham | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Grant | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Gray | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Greeley | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Greenwood | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Hamilton | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Harper | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Haskell | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Hodgeman | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Jackson | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Jefferson | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Jewell | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Kearny | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Kingman | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Kiowa | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Lane | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Lincoln | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Logan | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Lyon | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Marion | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Marshall | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
McPherson | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Meade | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Mitchell | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Montgomery | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Morris | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Morton | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Nemaha | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Neosho | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Ness | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Norton | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Osage | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Osborne | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Ottawa | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Pawnee | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Phillips | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Pottawatomie | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Pratt | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | 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 | |||||||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Rawlins | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Reno | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Republic | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Rice | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Riley | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Rooks | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Rush | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Russell | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Saline | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Scott | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Seward | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Sheridan | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Sherman | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Smith | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Stafford | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Stanton | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Stevens | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Sumner | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Thomas | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Trego | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Wabaunsee | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Wallace | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Washington | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Wichita | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Wilson | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in KS - H2944-204-0 Benefit Details |
Woodson | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Adair | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Atchison | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Audrain | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Bollinger | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Butler | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Caldwell | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Camden | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Cape Girardeau | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Carter | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Chariton | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Clark | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Cooper | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
DeKalb | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Dent | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Dunklin | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Gentry | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Grundy | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Harrison | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Holt | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Howard | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Howell | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Iron | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Knox | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Lewis | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Linn | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Macon | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Madison | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Maries | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Marion | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Mercer | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Mississippi | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Monroe | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Morgan | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
New Madrid | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Nodaway | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Oregon | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Pettis | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Putnam | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Ralls | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Randolph | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Ripley | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Schuyler | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Scotland | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Scott | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Shelby | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
St. Francois | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Stoddard | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Sullivan | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Texas | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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MOOP for A & B |
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Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Wayne | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in MO - H2944-204-0 Benefit Details |
Worth | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Alfalfa | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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Additional Gap Coverage |
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MOOP for A & B |
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Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Atoka | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Beaver | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Beckham | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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MOOP for A & B |
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Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Blaine | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Bryan | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Carter | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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MOOP for A & B |
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Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Cherokee | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Choctaw | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Cimarron | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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Additional Gap Coverage |
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Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Coal | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Comanche | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Cotton | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Custer | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Dewey | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Ellis | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Garfield | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Grant | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Greer | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Harmon | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Harper | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Hughes | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Jackson | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Jefferson | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Johnston | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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MOOP for A & B |
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Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Kay | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Kiowa | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Latimer | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Love | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Major | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
McCurtain | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Noble | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Nowata | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Okfuskee | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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MOOP for A & B |
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Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Pittsburg | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Pontotoc | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Pushmataha | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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MOOP for A & B |
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Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Roger Mills | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Stephens | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Texas | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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MOOP for A & B |
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Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Tillman | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Washita | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Woods | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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MOOP for A & B |
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Humana Gold Choice H2944-204 (PFFS) in OK - H2944-204-0 Benefit Details |
Woodward | $57.00 | $325 | Few Generics | Preferred Generic: $1.00 Non-Preferred Generic: $3.00 Preferred Brand: 17% Non-Preferred Brand: 30% Specialty Tier: 25% | n/a Browse Formulary | |||||
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