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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Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Adams | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Attala | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Benton | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Bolivar | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Calhoun | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Carroll | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Chickasaw | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Choctaw | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Claiborne | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Clarke | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Clay | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Coahoma | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Copiah | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Covington | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
DeSoto | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Forrest | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
George | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Greene | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Grenada | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Hancock | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Hinds | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Holmes | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Humphreys | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Issaquena | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Jasper | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Jefferson | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Jefferson Davis | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Jones | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Kemper | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Lafayette | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Lamar | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Lauderdale | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Lawrence | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Leake | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Lincoln | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Lowndes | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Madison | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Marion | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Marshall | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Monroe | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Montgomery | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Neshoba | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Newton | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Noxubee | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Oktibbeha | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Panola | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Perry | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Pike | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Prentiss | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Quitman | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Rankin | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Scott | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Sharkey | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Simpson | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Smith | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Stone | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Sunflower | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Tallahatchie | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Tate | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Tippah | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Tunica | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Union | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Walthall | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Warren | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Washington | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Wayne | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Webster | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Winston | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Yalobusha | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 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 | |||||||||
Windsor Medicare Extra Gold Plan (HMO) in MS - H5698-028-0 Benefit Details |
Yazoo | $35.00 | $0 | Some Generics | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $43.00 Non-Preferred Brand: $67.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
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