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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Today's Options Premier Plus 650J (PFFS) in AR - H5421-075-0 Benefit Details |
Drew | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in AR - H5421-075-0 Benefit Details |
Lafayette | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in AR - H5421-075-0 Benefit Details |
Little River | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in CA - H5421-075-0 Benefit Details |
Inyo | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in CA - H5421-075-0 Benefit Details |
Lassen | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in FL - H5421-075-0 Benefit Details |
Bay | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in FL - H5421-075-0 Benefit Details |
Dixie | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in FL - H5421-075-0 Benefit Details |
Hamilton | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in FL - H5421-075-0 Benefit Details |
Hardee | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in FL - H5421-075-0 Benefit Details |
Hendry | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in FL - H5421-075-0 Benefit Details |
Highlands | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in FL - H5421-075-0 Benefit Details |
Levy | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in FL - H5421-075-0 Benefit Details |
Monroe | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in FL - H5421-075-0 Benefit Details |
Walton | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Bacon | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Baker | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Bleckley | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Coffee | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Cook | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Dodge | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Dougherty | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Gordon | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Jeff Davis | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Lee | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Long | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Pierce | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Polk | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Schley | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Telfair | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Terrell | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Ware | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in GA - H5421-075-0 Benefit Details |
Wheeler | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in ID - H5421-075-0 Benefit Details |
Clearwater | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier Plus 650J (PFFS) in ID - H5421-075-0 Benefit Details |
Idaho | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in ID - H5421-075-0 Benefit Details |
Lewis | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in ID - H5421-075-0 Benefit Details |
Valley | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier Plus 650J (PFFS) in IL - H5421-075-0 Benefit Details |
Clay | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in IL - H5421-075-0 Benefit Details |
Fayette | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in IL - H5421-075-0 Benefit Details |
Gallatin | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Today's Options Premier Plus 650J (PFFS) in IL - H5421-075-0 Benefit Details |
Grundy | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in IL - H5421-075-0 Benefit Details |
Hamilton | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in IL - H5421-075-0 Benefit Details |
Perry | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in IL - H5421-075-0 Benefit Details |
Pulaski | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in IN - H5421-075-0 Benefit Details |
Starke | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in IN - H5421-075-0 Benefit Details |
Sullivan | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Barber | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Barton | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Brown | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Chase | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Chautauqua | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Clark | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Crawford | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Doniphan | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Edwards | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Finney | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Grant | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Greeley | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Greenwood | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Harper | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Haskell | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Hodgeman | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Jackson | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Jewell | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Kingman | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Logan | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Lyon | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Marshall | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Meade | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Ness | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Pawnee | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Reno | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Rice | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Scott | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Sherman | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Stafford | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Stanton | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Stevens | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Trego | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Wallace | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KS - H5421-075-0 Benefit Details |
Wichita | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Adair | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Bell | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Breathitt | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Carroll | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Casey | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Clay | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Clinton | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Crittenden | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Floyd | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Fulton | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Graves | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Greenup | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Knott | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Lawrence | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Leslie | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Letcher | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Muhlenberg | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Owen | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Perry | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Pike | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Todd | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in KY - H5421-075-0 Benefit Details |
Wolfe | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in LA - H5421-075-0 Benefit Details |
Evangeline | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in MS - H5421-075-0 Benefit Details |
Alcorn | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in MS - H5421-075-0 Benefit Details |
Amite | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in MS - H5421-075-0 Benefit Details |
Bolivar | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in MS - H5421-075-0 Benefit Details |
Humphreys | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in MS - H5421-075-0 Benefit Details |
Jefferson Davis | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in MO - H5421-075-0 Benefit Details |
Andrew | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in MO - H5421-075-0 Benefit Details |
Atchison | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in MO - H5421-075-0 Benefit Details |
Buchanan | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in MO - H5421-075-0 Benefit Details |
Daviess | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in MO - H5421-075-0 Benefit Details |
DeKalb | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in MO - H5421-075-0 Benefit Details |
Dent | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in MO - H5421-075-0 Benefit Details |
Gentry | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in MO - H5421-075-0 Benefit Details |
Linn | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in MO - H5421-075-0 Benefit Details |
Nodaway | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in MO - H5421-075-0 Benefit Details |
Perry | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in MO - H5421-075-0 Benefit Details |
Reynolds | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in MO - H5421-075-0 Benefit Details |
Ripley | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in MO - H5421-075-0 Benefit Details |
Ste. Genevieve | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in MT - H5421-075-0 Benefit Details |
Glacier | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in NE - H5421-075-0 Benefit Details |
Adams | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in NE - H5421-075-0 Benefit Details |
Antelope | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in NE - H5421-075-0 Benefit Details |
Custer | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in NE - H5421-075-0 Benefit Details |
Lincoln | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in NE - H5421-075-0 Benefit Details |
Nance | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in NE - H5421-075-0 Benefit Details |
Nuckolls | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in NE - H5421-075-0 Benefit Details |
Richardson | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in NE - H5421-075-0 Benefit Details |
Thurston | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in NE - H5421-075-0 Benefit Details |
Webster | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in NE - H5421-075-0 Benefit Details |
York | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in NV - H5421-075-0 Benefit Details |
Carson City | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in NV - H5421-075-0 Benefit Details |
Douglas | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in NV - H5421-075-0 Benefit Details |
Pershing | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in NV - H5421-075-0 Benefit Details |
White Pine | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in NC - H5421-075-0 Benefit Details |
Lenoir | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Adair | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Alfalfa | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Atoka | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Beckham | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Blaine | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Bryan | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Caddo | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Choctaw | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Cimarron | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Coal | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Cotton | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Harmon | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Jackson | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Johnston | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Marshall | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
McIntosh | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Noble | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Pittsburg | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Roger Mills | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Washita | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in OK - H5421-075-0 Benefit Details |
Woods | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Archer | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Bailey | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Baylor | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Blanco | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Borden | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Briscoe | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Castro | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Colorado | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Cooke | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
DeWitt | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Donley | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Fisher | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Gonzales | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Hardeman | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Kerr | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Mitchell | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Palo Pinto | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Sherman | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Starr | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Stephens | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in TX - H5421-075-0 Benefit Details |
Wichita | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in VA - H5421-075-0 Benefit Details |
Alleghany | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a 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 | |||||||||
Today's Options Premier Plus 650J (PFFS) in WA - H5421-075-0 Benefit Details |
Garfield | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Today's Options Premier Plus 650J (PFFS) in WA - H5421-075-0 Benefit Details |
Pacific | $107.00 | $130 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $10.50 Preferred Brand: $45.00 Non-Preferred Brand: $75.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
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