Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Adams |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Bond |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Brown |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Bureau |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Calhoun |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Carroll |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Cass |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Christian |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
De Witt |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Ford |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Fulton |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Greene |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Hancock |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Henderson |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Henry |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Jersey |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Jo Daviess |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Knox |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Livingston |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Logan |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Macoupin |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Madison |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Marshall |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Mason |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
McDonough |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
McLean |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Menard |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Mercer |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Monroe |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Montgomery |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Morgan |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Moultrie |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Peoria |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Piatt |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Pike |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Putnam |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Rock Island |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Sangamon |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Schuyler |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Scott |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
St. Clair |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Stark |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Stephenson |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Tazewell |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Warren |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Washington |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IL - H0084-001-0
Benefit Details
|
Woodford |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Adams |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Allen |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Blackford |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Brown |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
De Kalb |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Elkhart |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Fayette |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Fulton |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Grant |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Henry |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Huntington |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Jay |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Johnson |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Kosciusko |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Lagrange |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Marshall |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Miami |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Noble |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Parke |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Putnam |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Rush |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
St. Joseph |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Steuben |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Union |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Wabash |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Wells |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IN - H0084-001-0
Benefit Details
|
Whitley |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Adair |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Adams |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Appanoose |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Benton |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Boone |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Cass |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Cedar |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Clarke |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Clinton |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Crawford |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Davis |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Des Moines |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Fremont |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Greene |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Grundy |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Guthrie |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Hardin |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Harrison |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Henry |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Iowa |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Jasper |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Jefferson |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Johnson |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Keokuk |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Lee |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Louisa |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Lucas |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Madison |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Mahaska |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Marshall |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Mills |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Monona |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Montgomery |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Muscatine |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Polk |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Pottawattamie |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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|
|
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Poweshiek |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Ringgold |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Scott |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Shelby |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Tama |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Van Buren |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Warren |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in IA - H0084-001-0
Benefit Details
|
Washington |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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|
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Care Improvement Plus Medicare Advantage (PPO) in NE - H0084-001-0
Benefit Details
|
Burt |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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|
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Care Improvement Plus Medicare Advantage (PPO) in NE - H0084-001-0
Benefit Details
|
Cass |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in NE - H0084-001-0
Benefit Details
|
Cuming |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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Care Improvement Plus Medicare Advantage (PPO) in NE - H0084-001-0
Benefit Details
|
Douglas |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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|
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Care Improvement Plus Medicare Advantage (PPO) in NE - H0084-001-0
Benefit Details
|
Otoe |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in NE - H0084-001-0
Benefit Details
|
Sarpy |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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Care Improvement Plus Medicare Advantage (PPO) in NE - H0084-001-0
Benefit Details
|
Saunders |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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Care Improvement Plus Medicare Advantage (PPO) in NE - H0084-001-0
Benefit Details
|
Thurston |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in NE - H0084-001-0
Benefit Details
|
Washington |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
Bernalillo |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
Cibola |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
DeBaca |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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|
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Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
Eddy |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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|
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Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
Guadalupe |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
Lincoln |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
Los Alamos |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
Mora |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
Otero |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
Rio Arriba |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
Roosevelt |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
San Miguel |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
Sandoval |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
Santa Fe |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
Socorro |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
Torrance |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in NM - H0084-001-0
Benefit Details
|
Valencia |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in NC - H0084-001-0
Benefit Details
|
Avery |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in NC - H0084-001-0
Benefit Details
|
Bladen |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in NC - H0084-001-0
Benefit Details
|
Clay |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in NC - H0084-001-0
Benefit Details
|
Graham |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in NC - H0084-001-0
Benefit Details
|
Hoke |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in NC - H0084-001-0
Benefit Details
|
Polk |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in NC - H0084-001-0
Benefit Details
|
Transylvania |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Bailey |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Bexar |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Borden |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Bowie |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Brazoria |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Cass |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Collin |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Dallas |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Denton |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Dimmit |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Duval |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
El Paso |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Ellis |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Fort Bend |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Guadalupe |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Harris |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Hidalgo |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Hood |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Hunt |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Jefferson |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Johnson |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Liberty |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Montgomery |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Navarro |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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|
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Nueces |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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|
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Orange |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Polk |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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|
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Smith |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Tarrant |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Taylor |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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|
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Titus |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
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|
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Van Zandt |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Washington |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
|
Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Wood |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
|
|
|
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Care Improvement Plus Medicare Advantage (PPO) in TX - H0084-001-0
Benefit Details
|
Zavala |
$19.00 |
$315 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| $6,700 Browse Formulary |
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