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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MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Adjuntas | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Aguada | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Aguadilla | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Aguas Buenas | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Aibonito | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Anasco | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Arecibo | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Arroyo | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Barceloneta | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Barranquitas | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Bayamon | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Cabo Rojo | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Caguas | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Camuy | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Canovanas | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Carolina | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Catano | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Cayey | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Ceiba | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Ciales | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Cidra | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Coamo | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Comerio | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Corozal | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Culebra | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Dorado | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Fajardo | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Florida | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Guanica | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Guayama | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Guayanilla | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Guaynabo | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Gurabo | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Hatillo | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Hormigueros | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Humacao | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Isabela | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Jayuya | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Juana Diaz | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Juncos | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Lajas | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Lares | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Las Marias | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Las Piedras | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Loiza | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Luquillo | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Manati | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Maricao | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Maunabo | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Mayaguez | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Moca | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Morovis | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Naguabo | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Naranjito | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Orocovis | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Patillas | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Penuelas | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Ponce | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Quebradillas | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Rincon | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Rio Grande | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Sabana Grande | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Salinas | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
San German | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
San Juan | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
San Lorenzo | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
San Sebastian | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Santa Isabel | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Toa Alta | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Toa Baja | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Trujillo Alto | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Utuado | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Vega Alta | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Vega Baja | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Vieques | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 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 | |||||||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Villalba | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Yabucoa | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
MCS Classicare Premium Health (HMO) in PR - H4006-007-0 Benefit Details |
Yauco | $0.00 | $0 | Many Generics | Generic: $5.00 Preferred Brand: $25.00 Non-Preferred Brand: $50.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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