2016 Medicare Part D Contract ID/Plan ID Search

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Review 2016 Medicare Advantage plans

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There are 191 2016 Medicare Advantage plans (MAPD) meeting your criteria.

2016 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
Aetna Medicare Connect Plus (PPO) in AL - H5521-052-0 Benefit Details			Henry	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in AL - H5521-052-0 Benefit Details			Houston	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in AL - H5521-052-0 Benefit Details			Russell	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in AZ - H5521-052-0 Benefit Details			Maricopa	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in CA - H5521-052-0 Benefit Details			Orange	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in CA - H5521-052-0 Benefit Details			San Diego	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in CO - H5521-052-0 Benefit Details			Adams	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in CO - H5521-052-0 Benefit Details			Arapahoe	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in CO - H5521-052-0 Benefit Details			Boulder	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in CO - H5521-052-0 Benefit Details			Broomfield	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in CO - H5521-052-0 Benefit Details			Denver	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in CO - H5521-052-0 Benefit Details			Douglas	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in CO - H5521-052-0 Benefit Details			Jefferson	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in CT - H5521-052-0 Benefit Details			Fairfield	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in CT - H5521-052-0 Benefit Details			Hartford	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in CT - H5521-052-0 Benefit Details			Litchfield	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in CT - H5521-052-0 Benefit Details			New Haven	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in CT - H5521-052-0 Benefit Details			Tolland	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in DE - H5521-052-0 Benefit Details			New Castle	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in DE - H5521-052-0 Benefit Details			Sussex	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in FL - H5521-052-0 Benefit Details			Broward	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in FL - H5521-052-0 Benefit Details			Charlotte	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in FL - H5521-052-0 Benefit Details			Duval	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in FL - H5521-052-0 Benefit Details			Hillsborough	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in FL - H5521-052-0 Benefit Details			Lee	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in FL - H5521-052-0 Benefit Details			Manatee	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in FL - H5521-052-0 Benefit Details			Miami-Dade	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in FL - H5521-052-0 Benefit Details			Palm Beach	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in FL - H5521-052-0 Benefit Details			Pasco	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in FL - H5521-052-0 Benefit Details			Sarasota	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in FL - H5521-052-0 Benefit Details			St. Johns	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Barrow	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Bryan	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Chatham	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Chattahoochee	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Cherokee	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Clayton	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Columbia	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Coweta	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			DeKalb	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Douglas	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Evans	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Fayette	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Forsyth	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Fulton	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Gwinnett	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Hall	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Harris	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Marion	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			McDuffie	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			McIntosh	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Muscogee	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Newton	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Paulding	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Richmond	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in GA - H5521-052-0 Benefit Details			Rockdale	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in IL - H5521-052-0 Benefit Details			Cook	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in IN - H5521-052-0 Benefit Details			Allen	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in KY - H5521-052-0 Benefit Details			Boone	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in KY - H5521-052-0 Benefit Details			Campbell	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in KY - H5521-052-0 Benefit Details			Kenton	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in ME - H5521-052-0 Benefit Details			Androscoggin	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in ME - H5521-052-0 Benefit Details			Cumberland	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in ME - H5521-052-0 Benefit Details			Kennebec	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in ME - H5521-052-0 Benefit Details			Oxford	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in ME - H5521-052-0 Benefit Details			Penobscot	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in ME - H5521-052-0 Benefit Details			Piscataquis	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in ME - H5521-052-0 Benefit Details			Sagadahoc	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NJ - H5521-052-0 Benefit Details			Atlantic	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NJ - H5521-052-0 Benefit Details			Bergen	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NJ - H5521-052-0 Benefit Details			Burlington	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NJ - H5521-052-0 Benefit Details			Camden	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NJ - H5521-052-0 Benefit Details			Cumberland	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NJ - H5521-052-0 Benefit Details			Essex	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NJ - H5521-052-0 Benefit Details			Gloucester	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NJ - H5521-052-0 Benefit Details			Hudson	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NJ - H5521-052-0 Benefit Details			Middlesex	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NJ - H5521-052-0 Benefit Details			Morris	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NJ - H5521-052-0 Benefit Details			Ocean	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NJ - H5521-052-0 Benefit Details			Passaic	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NJ - H5521-052-0 Benefit Details			Salem	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NJ - H5521-052-0 Benefit Details			Sussex	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Albany	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Bronx	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Broome	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Cayuga	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Chemung	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Columbia	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Cortland	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Greene	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Livingston	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Monroe	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Nassau	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			New York	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Onondaga	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Ontario	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Orange	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Orleans	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Oswego	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Queens	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Rensselaer	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Richmond	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Rockland	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Schenectady	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Seneca	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Sullivan	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Tioga	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Wayne	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NY - H5521-052-0 Benefit Details			Yates	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Alexander	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Cabarrus	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Caldwell	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Caswell	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Catawba	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Davidson	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Durham	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Gaston	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Guilford	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Iredell	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Mecklenburg	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Orange	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Person	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Randolph	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Rockingham	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Rowan	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Union	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in NC - H5521-052-0 Benefit Details			Wake	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Ashland	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Brown	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Butler	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Clark	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Clermont	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Columbiana	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Cuyahoga	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Delaware	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Fairfield	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Franklin	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Geauga	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Hamilton	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Hancock	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Lake	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Licking	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Lucas	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Mahoning	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Marion	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Medina	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Miami	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Muskingum	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Portage	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Seneca	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Stark	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Summit	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Trumbull	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in OH - H5521-052-0 Benefit Details			Wood	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in PA - H5521-052-0 Benefit Details			Berks	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in PA - H5521-052-0 Benefit Details			Carbon	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in PA - H5521-052-0 Benefit Details			Lancaster	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in PA - H5521-052-0 Benefit Details			Lebanon	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in PA - H5521-052-0 Benefit Details			Lehigh	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in PA - H5521-052-0 Benefit Details			Monroe	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in PA - H5521-052-0 Benefit Details			Northampton	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in PA - H5521-052-0 Benefit Details			Schuylkill	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Alexandria City	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Arlington	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Chesterfield	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Danville City	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Fairfax	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Fairfax City	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Falls Church City	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Franklin	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Franklin City	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Fredericksburg City	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Gloucester	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Hampton City	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Hanover	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Henrico	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Henry	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Loudoun	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Manassas City	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Manassas Park City	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Martinsville City	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Newport News City	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Pittsylvania	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Prince William	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Richmond City	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Roanoke	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Roanoke City	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Spotsylvania	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			Stafford	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 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
Aetna Medicare Connect Plus (PPO) in VA - H5521-052-0 Benefit Details			York	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:
Aetna Medicare Connect Plus (PPO) in DC - H5521-052-0 Benefit Details			District of Columbia	$188.00	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%	$4,500 Browse Formulary
	--		Higher cost-sharing at standard network pharmacies. Details:

• 2016 PDP-Finder (Drug Only Plans)
• Compare 2015 & 2016 Plans
• 2016 PDP-DrugFinder (Formulary Drug Search)

Review 2016 Medicare Advantage plans

Chart Legend:

Below are a few notes to help with the understanding of the 2016 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.)
  
  (Search Tip: If you have selected an amount in the "LIS Subsidy Amount" filed, the premium shown is the premium based on your Low-Income Subsidy selection.
  
  
• Deductible: The standard CMS plan deductible is $360. Many Medicare plans do not have a deductible, however their plan 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.) Some plans that have an annual deductible exempt certain drug tiers from the deductible. For example, "Tier 1 exempt" may be shown. This would mean that Tier 1 drugs purchased during the Deductible phase, would not fall into the deductible and would be charged the Initial Coverage phase tier 1 cost-sharing.
  
  
• Gap Coverage: the Donut Hole: In the CMS Standard Plan, the beneficiary must pay the next $3,753 in drug costs (the Donut Hole). The Healthcare Reform provides that for Plan Year 2016, ALL formulary generics will have at least a 42% 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 $3,753;
  • 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 2016 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 2016 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 2016 is $3,310 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.
  
  

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(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.