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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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Adams | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Barnes | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Bowman | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Burleigh | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Cass | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Cavalier | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Dickey | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Dunn | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Eddy | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Emmons | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Foster | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Grand Forks | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Grant | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Griggs | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Hettinger | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Kidder | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
LaMoure | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Logan | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
McHenry | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
McIntosh | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
McLean | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Mercer | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Morton | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Oliver | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Pembina | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Pierce | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Ransom | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Richland | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Sargent | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Sheridan | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Sioux | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Stark | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Steele | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Stutsman | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Traill | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Walsh | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in ND - H2450-001-0 Benefit Details |
Ward | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Aurora | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Beadle | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Bennett | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Bon Homme | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Brookings | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Brown | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Brule | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Buffalo | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Butte | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Campbell | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Charles Mix | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Clark | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Clay | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Codington | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Custer | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Davison | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Day | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Deuel | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Dewey | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Douglas | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Edmunds | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Fall River | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Grant | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Gregory | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Haakon | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Hamlin | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Hand | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Hanson | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Harding | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Hughes | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Hutchinson | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Jackson | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Jerauld | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Jones | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Kingsbury | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Lake | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Lawrence | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Lincoln | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Lyman | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Marshall | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
McCook | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
McPherson | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Meade | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Mellette | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Miner | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Minnehaha | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Moody | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Pennington | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Perkins | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Roberts | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Sanborn | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Shannon | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Spink | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Stanley | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Todd | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Tripp | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Turner | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Union | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Yankton | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in SD - H2450-001-0 Benefit Details |
Ziebach | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in WI - H2450-001-0 Benefit Details |
Ashland | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in WI - H2450-001-0 Benefit Details |
Barron | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in WI - H2450-001-0 Benefit Details |
Bayfield | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in WI - H2450-001-0 Benefit Details |
Burnett | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in WI - H2450-001-0 Benefit Details |
Chippewa | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in WI - H2450-001-0 Benefit Details |
Douglas | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in WI - H2450-001-0 Benefit Details |
Dunn | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in WI - H2450-001-0 Benefit Details |
Eau Claire | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in WI - H2450-001-0 Benefit Details |
Pierce | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in WI - H2450-001-0 Benefit Details |
Polk | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in WI - H2450-001-0 Benefit Details |
Sawyer | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in WI - H2450-001-0 Benefit Details |
St. Croix | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in WI - H2450-001-0 Benefit Details |
Washburn | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Aitkin | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Anoka | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Becker | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Beltrami | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Benton | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Big Stone | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Blue Earth | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Brown | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Carlton | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Carver | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Cass | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Chippewa | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Chisago | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Clay | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Clearwater | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Cook | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Cottonwood | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Crow Wing | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Dakota | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Dodge | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Douglas | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Faribault | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Fillmore | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Freeborn | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Goodhue | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Grant | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Hennepin | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Houston | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Hubbard | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Isanti | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Itasca | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Jackson | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Kanabec | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Kandiyohi | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Kittson | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Koochiching | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Lac qui Parle | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Lake | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Lake of the Woods | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Le Sueur | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Lincoln | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Lyon | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Mahnomen | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Marshall | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Martin | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
McLeod | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Meeker | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Mille Lacs | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Morrison | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Mower | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Murray | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Nicollet | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Nobles | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Norman | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Olmsted | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Otter Tail | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Pennington | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Pine | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Pipestone | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Polk | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Pope | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Ramsey | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Red Lake | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Redwood | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Renville | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Rice | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Rock | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Roseau | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Scott | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Sherburne | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Sibley | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
St. Louis | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Stearns | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Steele | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | |||||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Stevens | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Swift | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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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 | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Todd | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Traverse | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Wabasha | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Wadena | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Waseca | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Washington | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Watonwan | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Wilkin | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Winona | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Wright | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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Medica Prime Solution Basic with Part D Option 2 (Cost) in MN - H2450-001-0 Benefit Details |
Yellow Medicine | $141.50 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic: $10.00 Preferred Brand: $39.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
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