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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Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) in IA - H5262-003-0 Benefit Details |
Allamakee | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) in IA - H5262-003-0 Benefit Details |
Clayton | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) in IA - H5262-003-0 Benefit Details |
Fayette | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $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 | |||||||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) in IA - H5262-003-0 Benefit Details |
Howard | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) in IA - H5262-003-0 Benefit Details |
Winneshiek | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) in WI - H5262-003-0 Benefit Details |
Buffalo | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $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 | |||||||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) in WI - H5262-003-0 Benefit Details |
Crawford | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) in WI - H5262-003-0 Benefit Details |
Grant | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) in WI - H5262-003-0 Benefit Details |
Jackson | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $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 | |||||||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) in WI - H5262-003-0 Benefit Details |
Juneau | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) in WI - H5262-003-0 Benefit Details |
La Crosse | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) in WI - H5262-003-0 Benefit Details |
Monroe | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $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 | |||||||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) in WI - H5262-003-0 Benefit Details |
Richland | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) in WI - H5262-003-0 Benefit Details |
Sauk | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) in WI - H5262-003-0 Benefit Details |
Trempealeau | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $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 | |||||||||
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) in WI - H5262-003-0 Benefit Details |
Vernon | $26.40 | $100 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Non-Preferred Generic: $33.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
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