HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Albemarle |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Alexandria City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Alleghany |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Amelia |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Arlington |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Augusta |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Bath |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Bedford |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Bedford City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Botetourt |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Brunswick |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Buckingham |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Buena Vista City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Caroline |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Charles City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Charlottesville City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Chesterfield |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Colonial Heights City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Covington City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Craig |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Culpeper |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Cumberland |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Dinwiddie |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Emporia City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Essex |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Falls Church City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Fauquier |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Floyd |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Fluvanna |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Franklin |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Franklin City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Fredericksburg City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Giles |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Gloucester |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Goochland |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Greene |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Greensville |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Hanover |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Henrico |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Highland |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Hopewell City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Isle of Wight |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
James City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
King and Queen |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
King George |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
King William |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Lancaster |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Lexington City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Loudoun |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Louisa |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Lunenburg |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Madison |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Manassas City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Manassas Park City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
new |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Mathews |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Middlesex |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Montgomery |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Nelson |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
New Kent |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Newport News City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Norfolk City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Northampton |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Northumberland |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Nottoway |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Orange |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Patrick |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Petersburg City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Poquoson City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Portsmouth City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Powhatan |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Prince Edward |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Prince George |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Prince William |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Pulaski |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Radford City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Richmond |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Richmond City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
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new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Roanoke |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Roanoke City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Rockingham |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Salem City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Southampton |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Spotsylvania |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Stafford |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Staunton City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Suffolk City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Surry |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Sussex |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Virginia Beach City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Waynesboro City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Westmoreland |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Williamsburg City |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
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HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
Wythe |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
HealthKeepers (Medicare-Medicaid Plan) in VA - H0147-001-0
Benefit Details
|
York |
$0.00 |
$0 |
Yes, some additional gap coverage. | Generic Drugs: $0.00 Brand Drugs: $0.00 Non-Medicare Rx Drugs: $0.00 Non-Medicare OTC Drugs: $0.00
| n/a Browse Formulary |
new |
new |
new |
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