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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SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Anderson | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Austin | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Bastrop | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Bell | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Bosque | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Brazos | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Burleson | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Burnet | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Cass | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Cherokee | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Coke | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Coleman | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Concho | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Coryell | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Crockett | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Falls | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Fayette | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Freestone | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Gregg | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Grimes | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Hamilton | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Harrison | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Henderson | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Hill | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Irion | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Kimble | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Lampasas | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Lee | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Leon | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Limestone | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Llano | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Madison | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Marion | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Mason | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
McCulloch | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
McLennan | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Menard | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Milam | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Mills | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Rains | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Reagan | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Robertson | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Runnels | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Rusk | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
San Saba | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Schleicher | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Smith | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Somervell | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Sterling | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Sutton | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Tom Green | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Travis | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Van Zandt | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Waller | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 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 | |||||||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Washington | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Williamson | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
SeniorCare Sr VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Wood | $191.60 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Brand: $64.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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