Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Allen |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Atchison |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Chase |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Chautauqua |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Cheyenne |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Clark |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Coffey |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Edwards |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Elk |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Finney |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Ford |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Geary |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Gove |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Graham |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Gray |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Jackson |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Jewell |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Kearny |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Lane |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Logan |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Lyon |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
McPherson |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Meade |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Mitchell |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Morton |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Ness |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Norton |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Osborne |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Phillips |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Rawlins |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Riley |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Rush |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Saline |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Scott |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Smith |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Stevens |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Trego |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Washington |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Wichita |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in KS - H2944-013-0
Benefit Details
|
Woodson |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Atchison |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Bollinger |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Butler |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Camden |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Cape Girardeau |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Carter |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Chariton |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Clark |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
DeKalb |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Dunklin |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Grundy |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Holt |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Lewis |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Macon |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Maries |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Marion |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Mercer |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a 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 |
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Mississippi |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Ralls |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Randolph |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Schuyler |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Scott |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Stoddard |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Sullivan |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
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Humana Gold Choice H2944-013 (PFFS) in MO - H2944-013-0
Benefit Details
|
Wayne |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
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Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Alfalfa |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Atoka |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
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Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Beckham |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
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Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Bryan |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Choctaw |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
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Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Coal |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
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Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Grant |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Jackson |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
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Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Jefferson |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
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Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Love |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Major |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
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Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
McCurtain |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
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Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Okfuskee |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Pontotoc |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
|
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Pushmataha |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
|
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Tillman |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Woods |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
|
|
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Humana Gold Choice H2944-013 (PFFS) in OK - H2944-013-0
Benefit Details
|
Woodward |
$92.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $7.00 Non-Preferred Generic: $14.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%
| n/a Browse Formulary |
|
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