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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Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Allendale | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Bamberg | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Barnwell | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Beaufort | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Berkeley | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Charleston | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Chesterfield | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Colleton | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Darlington | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Dillon | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Dorchester | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Florence | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Georgetown | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Hampton | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Horry | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Jasper | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Kershaw | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Lancaster | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Lee | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Marion | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Marlboro | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Medicare Blue (PPO) in SC - H4209-003-0 Benefit Details |
Williamsburg | $38.50 | $195 | Many Generics | Preferred Generic: $2.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $85.00 Specialty Tier: 27% | $6,700 Browse Formulary | |||||
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