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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Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Berkeley | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Boone | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Braxton | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 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 | |||||||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Cabell | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Calhoun | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Clay | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 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 | |||||||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Doddridge | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Gilmer | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Grant | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 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 | |||||||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Hardy | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Jackson | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Jefferson | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 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 | |||||||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Kanawha | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Lewis | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Lincoln | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 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 | |||||||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Logan | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Mason | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Mingo | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Nicholas | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Ohio | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Pendleton | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Putnam | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Ritchie | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Roane | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Tucker | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Upshur | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Wayne | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Freedom Blue PPO HD (PPO) in WV - H5106-025-0 Benefit Details |
Wirt | $12.00 | $150 | No additional gap coverage, only the Donut Hole Discount | Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $90.00 Specialty Tier: 29% | $5,000 Browse Formulary | |||||
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