Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Adams |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Allen |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Ashtabula |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Auglaize |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Brown |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Butler |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Carroll |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Champaign |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Clark |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Clermont |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Clinton |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Columbiana |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Crawford |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Cuyahoga |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Darke |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Fayette |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Fulton |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Gallia |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Geauga |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Greene |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Hamilton |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Hardin |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Harrison |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Henry |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Highland |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Hocking |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Holmes |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Jackson |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Jefferson |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Lake |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Lawrence |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Licking |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Logan |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Lorain |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Lucas |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Madison |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Mahoning |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Medina |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Mercer |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Miami |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Monroe |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Montgomery |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Morrow |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Noble |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Ottawa |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Paulding |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Perry |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Pickaway |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Pike |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Portage |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Preble |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Putnam |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Shelby |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Stark |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Summit |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Trumbull |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Van Wert |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| 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 |
Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Vinton |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Gold (HMO SNP) in OH - H9190-003-0
Benefit Details
|
Warren |
$59.00 |
$360 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% Select Care Drugs: $11.00
| n/a Browse Formulary |
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