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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Advantra Option 2 (HMO-POS) in IL - H2663-002-0 Benefit Details |
Bond | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in IL - H2663-002-0 Benefit Details |
Calhoun | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in IL - H2663-002-0 Benefit Details |
Clinton | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 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 | |||||||||
Advantra Option 2 (HMO-POS) in IL - H2663-002-0 Benefit Details |
Greene | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in IL - H2663-002-0 Benefit Details |
Jersey | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in IL - H2663-002-0 Benefit Details |
Madison | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 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 | |||||||||
Advantra Option 2 (HMO-POS) in IL - H2663-002-0 Benefit Details |
Monroe | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in IL - H2663-002-0 Benefit Details |
Randolph | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in IL - H2663-002-0 Benefit Details |
St. Clair | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 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 | |||||||||
Advantra Option 2 (HMO-POS) in IL - H2663-002-0 Benefit Details |
Washington | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Audrain | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Boone | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 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 | |||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Callaway | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Cole | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Cooper | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 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 | |||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Crawford | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Franklin | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Gasconade | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Howard | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Jefferson | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Knox | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Lincoln | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Miller | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Moniteau | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Montgomery | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Osage | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Perry | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Pike | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Randolph | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Shelby | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
St. Charles | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
St. Louis | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
St. Louis City | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 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 |
|||||
Service | Exper. | Cost Info | |||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Ste. Genevieve | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Warren | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Advantra Option 2 (HMO-POS) in MO - H2663-002-0 Benefit Details |
Washington | $96.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $30.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | $2,900 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: |
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