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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Humana Gold Plus H6622-003 (HMO-POS) in WI - H6622-003-0 Benefit Details |
Barron | $32.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Humana Gold Plus H6622-003 (HMO-POS) in WI - H6622-003-0 Benefit Details |
Buffalo | $32.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Humana Gold Plus H6622-003 (HMO-POS) in WI - H6622-003-0 Benefit Details |
Chippewa | $32.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 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 | |||||||||
Humana Gold Plus H6622-003 (HMO-POS) in WI - H6622-003-0 Benefit Details |
Dunn | $32.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Humana Gold Plus H6622-003 (HMO-POS) in WI - H6622-003-0 Benefit Details |
Eau Claire | $32.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Humana Gold Plus H6622-003 (HMO-POS) in WI - H6622-003-0 Benefit Details |
Jackson | $32.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 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 | |||||||||
Humana Gold Plus H6622-003 (HMO-POS) in WI - H6622-003-0 Benefit Details |
La Crosse | $32.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Humana Gold Plus H6622-003 (HMO-POS) in WI - H6622-003-0 Benefit Details |
Monroe | $32.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Humana Gold Plus H6622-003 (HMO-POS) in WI - H6622-003-0 Benefit Details |
Pepin | $32.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 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 | |||||||||
Humana Gold Plus H6622-003 (HMO-POS) in WI - H6622-003-0 Benefit Details |
Polk | $32.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Humana Gold Plus H6622-003 (HMO-POS) in WI - H6622-003-0 Benefit Details |
Trempealeau | $32.00 | $0 | Few Generics, Few Brands | Preferred Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
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