2015 Medicare Part D Contract ID/Plan ID Search

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2015 Medicare Part D Contract ID/Plan ID Search

This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

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Review 2015 Medicare Advantage plans

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**There are 228 2015 Medicare Advantage plans (MAPD) meeting your criteria.**
2015 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips
Plan Name			County	Monthly Prem. (Parts C & D)	Deduct- ible	(Donut Hole) Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance 30-Day Supply	MOOP for Part A & B Benefits
Cust. Service Rating	Member Plan Exper.	RxCost Info Rating	County	Monthly Prem. (Parts C & D)	Deduct- ible	(Donut Hole) Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance 30-Day Supply	MOOP for Part A & B Benefits
UnitedHealthcare MedicareDirect Rx (PFFS) in AZ - H5435-024-0 Benefit Details			Navajo	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in CA - H5435-024-0 Benefit Details			Alpine	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in CA - H5435-024-0 Benefit Details			Calaveras	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in CA - H5435-024-0 Benefit Details			Colusa	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in CA - H5435-024-0 Benefit Details			Del Norte	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in CA - H5435-024-0 Benefit Details			Humboldt	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in CA - H5435-024-0 Benefit Details			Mendocino	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in CA - H5435-024-0 Benefit Details			Merced	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in CA - H5435-024-0 Benefit Details			Modoc	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in CA - H5435-024-0 Benefit Details			Plumas	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in CA - H5435-024-0 Benefit Details			Siskiyou	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in CA - H5435-024-0 Benefit Details			Trinity	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Berrien	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Calhoun	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Carroll	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Chattooga	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Clay	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Clinch	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Crisp	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Decatur	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Fannin	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Gilmer	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Grady	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Haralson	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Heard	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Irwin	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Lamar	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Lanier	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Macon	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Pike	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Quitman	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Schley	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Sumter	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Terrell	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Thomas	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Tift	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Towns	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Troup	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Turner	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in GA - H5435-024-0 Benefit Details			Union	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in IN - H5435-024-0 Benefit Details			Bartholomew	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Chase	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Cheyenne	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Clay	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Decatur	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Ellis	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Geary	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Graham	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Lane	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Logan	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Marshall	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			McPherson	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Nemaha	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Neosho	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Phillips	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Rawlins	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Republic	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Riley	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Rooks	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Saline	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Scott	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Sheridan	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Thomas	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Washington	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KS - H5435-024-0 Benefit Details			Wilson	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KY - H5435-024-0 Benefit Details			Allen	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in KY - H5435-024-0 Benefit Details			Calloway	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KY - H5435-024-0 Benefit Details			Carter	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KY - H5435-024-0 Benefit Details			Christian	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in KY - H5435-024-0 Benefit Details			Cumberland	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KY - H5435-024-0 Benefit Details			Lyon	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KY - H5435-024-0 Benefit Details			Marshall	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in KY - H5435-024-0 Benefit Details			Monroe	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KY - H5435-024-0 Benefit Details			Trigg	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in KY - H5435-024-0 Benefit Details			Wayne	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in LA - H5435-024-0 Benefit Details			Avoyelles	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Adair	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Bollinger	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Caldwell	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Cape Girardeau	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Clark	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Daviess	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Grundy	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Iron	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Knox	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Lewis	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Madison	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Maries	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Marion	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Mercer	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			New Madrid	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Pike	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Putnam	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Ralls	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Randolph	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Schuyler	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Scotland	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Scott	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Shannon	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Stoddard	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Sullivan	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MO - H5435-024-0 Benefit Details			Wayne	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Blaine	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Carter	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Daniels	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Dawson	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Deer Lodge	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Fallon	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Garfield	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Golden Valley	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Liberty	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Lincoln	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Madison	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Petroleum	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Phillips	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Powder River	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Prairie	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Roosevelt	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Sheridan	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Silver Bow	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Toole	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in MT - H5435-024-0 Benefit Details			Treasure	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Arthur	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Banner	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Blaine	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Boone	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Buffalo	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Cedar	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Cheyenne	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Dakota	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Dawes	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Dawson	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Gosper	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Hall	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Hooker	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Keith	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Keya Paha	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Knox	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Logan	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Loup	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Madison	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			McPherson	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Merrick	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Morrill	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Nance	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Perkins	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Platte	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Scotts Bluff	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Sheridan	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Sherman	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Stanton	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Thomas	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NE - H5435-024-0 Benefit Details			Wheeler	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in NH - H5435-024-0 Benefit Details			Belknap	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NH - H5435-024-0 Benefit Details			Cheshire	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NH - H5435-024-0 Benefit Details			Grafton	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in NH - H5435-024-0 Benefit Details			Merrimack	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NC - H5435-024-0 Benefit Details			Buncombe	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in NC - H5435-024-0 Benefit Details			Burke	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in NC - H5435-024-0 Benefit Details			Yancey	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in OK - H5435-024-0 Benefit Details			Latimer	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in OK - H5435-024-0 Benefit Details			Okfuskee	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in OK - H5435-024-0 Benefit Details			Pontotoc	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in OK - H5435-024-0 Benefit Details			Pushmataha	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Blanco	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Brewster	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Brooks	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Brown	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Calhoun	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Colorado	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Comanche	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Crane	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Culberson	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			DeWitt	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Duval	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Eastland	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Erath	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Frio	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Goliad	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Gonzales	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Jack	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Jackson	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Karnes	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Kerr	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			La Salle	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Lavaca	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Live Oak	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Loving	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Matagorda	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Maverick	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			McMullen	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Pecos	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Presidio	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Reeves	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Refugio	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Terrell	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Victoria	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Ward	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in TX - H5435-024-0 Benefit Details			Winkler	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in VT - H5435-024-0 Benefit Details			Caledonia	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in VT - H5435-024-0 Benefit Details			Essex	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in VT - H5435-024-0 Benefit Details			Franklin	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in VT - H5435-024-0 Benefit Details			Grand Isle	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in VT - H5435-024-0 Benefit Details			Lamoille	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in VT - H5435-024-0 Benefit Details			Washington	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in VT - H5435-024-0 Benefit Details			Windham	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in VT - H5435-024-0 Benefit Details			Windsor	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in VA - H5435-024-0 Benefit Details			Augusta	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in VA - H5435-024-0 Benefit Details			Brunswick	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in VA - H5435-024-0 Benefit Details			Carroll	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in VA - H5435-024-0 Benefit Details			Danville City	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in VA - H5435-024-0 Benefit Details			Greensville	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in VA - H5435-024-0 Benefit Details			Harrisonburg City	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in VA - H5435-024-0 Benefit Details			Henry	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in VA - H5435-024-0 Benefit Details			Martinsville City	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in VA - H5435-024-0 Benefit Details			Mecklenburg	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in VA - H5435-024-0 Benefit Details			Patrick	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in VA - H5435-024-0 Benefit Details			Rockingham	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in VA - H5435-024-0 Benefit Details			Spotsylvania	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in VA - H5435-024-0 Benefit Details			Staunton City	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in VA - H5435-024-0 Benefit Details			Waynesboro City	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in WY - H5435-024-0 Benefit Details			Albany	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in WY - H5435-024-0 Benefit Details			Crook	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in WY - H5435-024-0 Benefit Details			Fremont	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in WY - H5435-024-0 Benefit Details			Natrona	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 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	County	Monthly Prem.	Deduct- ible	Additional Gap Coverage	Preferred Pharmacy Copay/ Coinsurance	MOOP for A & B
UnitedHealthcare MedicareDirect Rx (PFFS) in WY - H5435-024-0 Benefit Details			Sheridan	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in WY - H5435-024-0 Benefit Details			Teton	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

UnitedHealthcare MedicareDirect Rx (PFFS) in WY - H5435-024-0 Benefit Details			Weston	$43.00	$185	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33%	n/a Browse Formulary

Review 2015 Medicare Advantage plans

Chart Legend:

Below are a few notes to help with the understanding of the 2015 Medicare Part D Prescription Drug Plan chart above and Search Tips to help you narrow down your list of plans to those that best meet your needs.

Plan Name: This is the official plan name from the Centers for Medicare and Medicaid Services (CMS). The same plan name generally has a different plan id in each state. (Search Tip: If you would like to reduce the plans shown to just plans for one or two specific carriers, you can select the carrier name in the "Plan Family" fields 1 and 2. Select the empty (blank) option at the top of the list to remove the criteria. You can also click the "National Plans" checkbox to limit your search to just national plans.)
CMS Plan Ratings: these are found under the Plan Name at the left side of the chart.

This is a 1 to 5 star rating system with five (5) stars as excellent, four (4) stars as very good, three (3) stars as good, two (2) stars as fair and one (1) star as poor.

Cust. Service Rating - Drug Plan Customer Service - Medicare and members rate the drug plan and how well a drug plan provides customer service.

This category includes measures of how drug plans rate on the following areas:
- Time on Hold When Customer and Pharmacist Calls Drug Plan.
- Calls Disconnected When Customer and Pharmacist Calls Drug Plan.
- Drug Plan’s Timeliness in Giving a Decision for Members Who Make an Appeal.
- Fairness of Drug Plan’s Denials to a Member’s Appeal, Based on an Independent Reviewer.
Member Plan Exper. - Member Experience with Drug Plan - This category shows how well drug plans make prescription drugs available to their members.

This category includes measures of how drug plans rate on the following areas:
- Drug Plan Provides Information or Help When Members Need It.
- Members’ Overall Rating of Drug Plan.
- Members’ Ability to Get Prescriptions Filled Easily When Using the Drug Plan.
RxCost Info Rating - This category shows how well drug plans are doing with pricing prescriptions and providing information on the Medicare website.

This category includes measures of how drug plans rate on the following areas:
- Completeness of the Drug Plan’s Information on Members Who Need Extra Help.
- Drug Plan Provides Current Information on Costs and Coverage for Medicare’s Website (the same data is used on this Q1Medicare.com).
- Drug Plan’s Prices that Did Not Increase More Than Expected During the Year.
- Drug Plan’s Prices on Medicare’s Website (and this website) Are Similar to the Prices Members Pay at the Pharmacy.
- Drug Plan’s Members 65 and Older Who Received Prescriptions for Certain Drugs with a High Risk of Side Effects, when There May Be Safer Drug Choices.
Monthly Premium: This is the amount you must pay each month to use the plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase. (Search Tip: If you would like to reduce the plans shown to just plans under a certain premium, enter this value in the "Maximum Premium" field.)
Deductible: This is the $320 deductible that was presented in the CMS Standard Plan. Many provider’s plans do not have a deductible, however the premium may be higher. (Search Tip: If you would like to reduce the plans shown to just plans with a deductible under a certain value, enter this value in the "Maximum Deductible field" field.)
Gap Coverage: the Donut Hole: In the CMS Standard Plan, the beneficiary must pay the next $3,720 in drug costs (the Donut Hole). The Healthcare Reform provides that for Plan Year 2015, ALL formulary generics will have at least a 35% discount and ALL brand drugs will have at least a 55% discount in the coverage gap. The Gap Coverage Types discussed in this section are in addition to the Healthcare Reform mandated discounts. In our chart, you will see one of the following:
- No Gap Coverage: you must pay the $3,720;
- Yes: This plan offers some level of gap coverage.
$0 Premium with Full LIS - Does the plan Qualify for $0 Premium with Full Low-Income Subsidy?: If Yes is in the field, then you would pay a $0 premium if you have a Full Low-Income Subsidy (LIS). If No is in the field, then you would be responsible for the difference between what the state provides as the Full Low-Income Subsidy and the actual cost of the plan even if you have a Full Low-Income Subsidy. (Search Tip: If you would like to reduce the plans shown to just plans that qualify for the $0 premium (Benchmark plans), select "Yes..." in the "Full Low-Income Subsidy?" field.)
Plan ID: This is the unique id for this particular plan.
Copay / Coinsurance - Cost Sharing - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. Plans can form their own tiers, so you should contact the plan or reference their summary of benefits to find out what copays and limitations are associated with each tier. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. (Search Tip: If you would like to reduce the plans shown to just plans that have a tier 1 (Generics) co-pay of up to a certain value (ex: $0 co-pay), enter the value (ex: 0) in the "Max. Co-pay Tier 1 (Generics)" field.)

Additional Information Fields:
You can select one of the following additional pieces of plan information to display (Search Tip: to change the type of information shown in the last column of the chart, select the data to be shown in the "Additional Info" field.)

Total Formulary Drugs (default) - This is the total number of medications on the plans formulary or drug list. This total drug count does not include "Bonus Drugs". These are non-Medicare Part D drugs which are covered by the plan, however they do not count toward your plan deductible, retail drug cost, or TrOOP.
Plan’s Summary Star Rating - This is the overall star rating for the Medicare Part D plan. To learn more about the star ratings, please see our Plan Quality Star Ratings.
Offers Mail Order - "Yes" is displayed if this plan offers mail order on any medications. It does NOT mean that ALL medications are available through mail order.
Members in This State (updated: September 2015 figures) - This is the total number of members in this plan for this PDP CMS Region. For regions that contain more than one state, this is the total for all of those states combined. If the CMS Region contains more than one state, the actual state enrollment is shown, along with the CMS region and national enrollment figures on the plan details page. you can access the plan details by clicking the plan name, orange enroll options button, or the plan details icon.
Members Nation Wide (updated: September 2015 figures) - This is the total number of member for this plan in all CMS Regions (States) combined.
Initial Coverage Limit (ICL) - The initial coverage limit phase of a Medicare Part D plan is the phase AFTER the initial deductible is met (if the plan has an initial deductible) and BEFORE the coverage gap (or donut hole) begins. The ICL is the phase of the prescription drug plan during which you and your plan share your prescription costs. During this phase you will pay either a co-payment (a flat fee per prescription) or co-insurance (a percentage of the drug cost). The details of the cost-sharing for the plan are shown in the Cost-Sharing column directly to the left of this column. The CMS standard Initial Coverage Limit for 2015 is $2,960 and increases each year.
National or Regional Plans - This column simply displays the word "National" if the plan is sponsored by a national carrier or "Regional" if the plan sponsor is a regional carrier.

(Chart Source: various files provided by the Centers for Medicare and Medicaid Services along with data from the Medicare.gov website plan finder.)

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, we cannot guarantee the accuracy of this information.

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