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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Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Alamance | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Alexander | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Alleghany | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Anson | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Ashe | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Avery | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Beaufort | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Bertie | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Bladen | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Brunswick | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Cabarrus | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Caldwell | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Carteret | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Caswell | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Catawba | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Chatham | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Chowan | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Cleveland | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Columbus | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Cumberland | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Davidson | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Davie | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Duplin | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Durham | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Edgecombe | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Forsyth | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Franklin | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Gaston | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Gates | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Granville | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Greene | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Guilford | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Halifax | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Harnett | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Haywood | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Henderson | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Hertford | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Hoke | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Hyde | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Iredell | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Johnston | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Jones | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Lee | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Lincoln | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Madison | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Martin | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
McDowell | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Mecklenburg | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Mitchell | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Montgomery | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Nash | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
New Hanover | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Northampton | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Onslow | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Orange | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Pamlico | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Pender | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Perquimans | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Person | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Pitt | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Polk | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Randolph | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Richmond | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Robeson | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Rockingham | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Rowan | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Sampson | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Scotland | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Stanly | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Stokes | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Surry | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Tyrrell | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Union | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Vance | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Wake | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Warren | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Washington | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Watauga | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Wayne | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Wilkes | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Wilson | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $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 | |||||||||
Blue Medicare PPO Enhanced (PPO) in NC - H3404-001-0 Benefit Details |
Yadkin | $47.20 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $25.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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