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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SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Anderson | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Austin | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Bastrop | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Bell | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Blanco | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Bosque | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Brazos | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Burleson | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Burnet | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Cass | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Cherokee | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Coke | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Coleman | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Colorado | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Concho | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Coryell | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Crockett | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Falls | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Fayette | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Freestone | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Gregg | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Grimes | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Hamilton | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Harrison | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Henderson | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Hill | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Irion | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Kimble | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Lampasas | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Lavaca | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Lee | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Leon | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Limestone | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Llano | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Madison | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Marion | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Mason | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
McCulloch | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
McLennan | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Menard | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Milam | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Mills | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Rains | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Reagan | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Robertson | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Runnels | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Rusk | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
San Saba | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Schleicher | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Smith | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Somervell | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Sterling | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Sutton | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Tom Green | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Travis | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Van Zandt | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Waller | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a 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 | |||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Washington | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Williamson | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: | ||||||||||
SeniorCare Sr Premium - Basic Rx (Cost) in TX - H4564-001-0 Benefit Details |
Wood | $235.70 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
-- | Higher cost-sharing at standard network pharmacies. Details: |
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