WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Adams |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Attala |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Bolivar |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Carroll |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Claiborne |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Clarke |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Coahoma |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Copiah |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
DeSoto |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Grenada |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Hinds |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Holmes |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Humphreys |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Issaquena |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Jefferson |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Jefferson Davis |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Kemper |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Lafayette |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Lauderdale |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Lawrence |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Leake |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Lincoln |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Madison |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Marshall |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Neshoba |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Newton |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Panola |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Pike |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Quitman |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Rankin |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Scott |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Sharkey |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Simpson |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Smith |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Sunflower |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Tallahatchie |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Tate |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Tunica |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Walthall |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Warren |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Washington |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
WellCare Gold Essential (HMO) in MS - H5698-028-0
Benefit Details
|
Yazoo |
$40.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 33%
| $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|