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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Alamance | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Alexander | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Alleghany | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Anson | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Ashe | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Avery | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Beaufort | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Bertie | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Bladen | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Brunswick | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Cabarrus | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Caldwell | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Carteret | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Caswell | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Catawba | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Chatham | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Chowan | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Cleveland | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Columbus | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Cumberland | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Davidson | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Davie | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Duplin | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Durham | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Edgecombe | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Forsyth | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Franklin | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Gaston | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Gates | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Granville | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Greene | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Guilford | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Halifax | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Harnett | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Haywood | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Henderson | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Hertford | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Hoke | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Hyde | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Iredell | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Johnston | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Jones | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Lee | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Lincoln | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Madison | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Martin | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
McDowell | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Mecklenburg | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Mitchell | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Montgomery | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Nash | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
New Hanover | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Northampton | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Onslow | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Orange | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Pamlico | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Pender | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Perquimans | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Person | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Pitt | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Polk | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Randolph | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Richmond | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Robeson | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Rockingham | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Rowan | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Sampson | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Scotland | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Stanly | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Stokes | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Surry | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Tyrrell | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Union | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Vance | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Wake | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Warren | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Washington | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Watauga | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Wayne | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Wilkes | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Blue Medicare HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Wilson | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 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 HMO Enhanced (HMO) in NC - H3449-005-0 Benefit Details |
Yadkin | $16.40 | $0 | Some Generics, Few Brands | Preferred Generic: $4.00 Non-Preferred Generic: $20.00 Preferred Brand: $30.00 Non-Preferred Brand: $70.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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