BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Alachua |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Baker |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Bay |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Bradford |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Brevard |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Broward |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Calhoun |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Charlotte |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Citrus |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Clay |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Collier |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Columbia |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
DeSoto |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Dixie |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Duval |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Escambia |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Flagler |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Franklin |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Gadsden |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Gilchrist |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Glades |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Gulf |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Hamilton |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Hardee |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Hendry |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Hernando |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Highlands |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Hillsborough |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Holmes |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Indian River |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Jackson |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Jefferson |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Lafayette |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Lake |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Lee |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Leon |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Levy |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Liberty |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Madison |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Manatee |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Marion |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Martin |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Miami-Dade |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Monroe |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Nassau |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Okaloosa |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Okeechobee |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Orange |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Osceola |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Palm Beach |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Pasco |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Pinellas |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Polk |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Putnam |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Santa Rosa |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Sarasota |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Seminole |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
St. Johns |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
St. Lucie |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Sumter |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Suwannee |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Taylor |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Union |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Volusia |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Wakulla |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Walton |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 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 |
BlueMedicare Regional PPO (Regional PPO) in FL - R3332-001-0
Benefit Details
|
Washington |
$36.10 |
$100 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $28.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 25%
| $6,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|