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 Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
Abbeville | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
Cherokee | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
Chester | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
Clarendon | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
Colleton | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
Fairfield | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
Greenville | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
Greenwood | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
Kershaw | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
Lee | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
McCormick | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
Newberry | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
Orangeburg | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
Pickens | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
Saluda | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | 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 | |||||||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
Spartanburg | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
Windsor Medicare Extra Diabetes Plan (HMO SNP) in SC - H5698-163-0 Benefit Details |
Union | $78.00 | $0 | Some Generics | Preferred Generic: $4.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $60.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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