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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Anderson | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Austin | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Bastrop | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Bell | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Blanco | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Bosque | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Brazos | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Burleson | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Burnet | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Cass | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Cherokee | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Coke | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Coleman | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Colorado | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Concho | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Coryell | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Crockett | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Falls | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Fayette | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Freestone | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Gregg | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Grimes | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Hamilton | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Harrison | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Henderson | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Hill | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Irion | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Kimble | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Lampasas | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Lavaca | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Lee | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Leon | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Limestone | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Llano | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Madison | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Marion | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Mason | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
McCulloch | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
McLennan | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Menard | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Milam | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Mills | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Rains | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Reagan | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Robertson | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Runnels | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Rusk | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
San Saba | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Schleicher | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Smith | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Somervell | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Sterling | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Sutton | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Tom Green | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Travis | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Van Zandt | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Waller | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Washington | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Williamson | $195.60 | $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 VIP - Basic Rx (Cost) in TX - H4564-017-0 Benefit Details |
Wood | $195.60 | $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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