2014 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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KelseyCare Advantage Rx Premier (HMO) in TX - H0332-006-0 Benefit Details |
Fort Bend | $223.10 | $50 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $20.00 Preferred Brand: $20.00 Non-Preferred Brand: $50.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
KelseyCare Advantage Rx Premier (HMO) in TX - H0332-006-0 Benefit Details |
Galveston | $223.10 | $50 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $20.00 Preferred Brand: $20.00 Non-Preferred Brand: $50.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
KelseyCare Advantage Rx Premier (HMO) in TX - H0332-006-0 Benefit Details |
Harris | $223.10 | $50 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $20.00 Preferred Brand: $20.00 Non-Preferred Brand: $50.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
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 | |||||||||
KelseyCare Advantage Rx Premier (HMO) in TX - H0332-006-0 Benefit Details |
Montgomery | $223.10 | $50 | Many Generics | Preferred Generic: $0.00 Non-Preferred Generic: $20.00 Preferred Brand: $20.00 Non-Preferred Brand: $50.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: |
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