2014 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
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 |
|||||||||
Gundersen Senior Preferred Elite (w/RX) (HMO) in WI - H5262-001-0 Benefit Details |
Buffalo | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
Gundersen Senior Preferred Elite (w/RX) (HMO) in WI - H5262-001-0 Benefit Details |
Crawford | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
Gundersen Senior Preferred Elite (w/RX) (HMO) in WI - H5262-001-0 Benefit Details |
Grant | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Gundersen Senior Preferred Elite (w/RX) (HMO) in WI - H5262-001-0 Benefit Details |
Jackson | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
Gundersen Senior Preferred Elite (w/RX) (HMO) in WI - H5262-001-0 Benefit Details |
Juneau | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
Gundersen Senior Preferred Elite (w/RX) (HMO) in WI - H5262-001-0 Benefit Details |
La Crosse | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Gundersen Senior Preferred Elite (w/RX) (HMO) in WI - H5262-001-0 Benefit Details |
Monroe | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
Gundersen Senior Preferred Elite (w/RX) (HMO) in WI - H5262-001-0 Benefit Details |
Richland | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
Gundersen Senior Preferred Elite (w/RX) (HMO) in WI - H5262-001-0 Benefit Details |
Sauk | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Gundersen Senior Preferred Elite (w/RX) (HMO) in WI - H5262-001-0 Benefit Details |
Trempealeau | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
Gundersen Senior Preferred Elite (w/RX) (HMO) in WI - H5262-001-0 Benefit Details |
Vernon | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
Gundersen Senior Preferred Elite (w/RX) (HMO) in IA - H5262-001-0 Benefit Details |
Allamakee | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Gundersen Senior Preferred Elite (w/RX) (HMO) in IA - H5262-001-0 Benefit Details |
Clayton | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
Gundersen Senior Preferred Elite (w/RX) (HMO) in IA - H5262-001-0 Benefit Details |
Fayette | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
Gundersen Senior Preferred Elite (w/RX) (HMO) in IA - H5262-001-0 Benefit Details |
Howard | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Gundersen Senior Preferred Elite (w/RX) (HMO) in IA - H5262-001-0 Benefit Details |
Winneshiek | $154.30 | $40 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $8.00 Non-Preferred Generic: $30.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 32% | $3,400 Browse Formulary | |||||
|