Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Anderson |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Bath |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Boone |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Bourbon |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Boyd |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Boyle |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Bracken |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Bullitt |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Butler |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Caldwell |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Campbell |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Carroll |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Carter |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Clark |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Clay |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Crittenden |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Estill |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Fayette |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Franklin |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Gallatin |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Garrard |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Grant |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Greenup |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Harrison |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Henderson |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Henry |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Hopkins |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Jackson |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Jefferson |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Jessamine |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Kenton |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Knox |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Larue |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Lawrence |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Lee |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Leslie |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Lewis |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Lincoln |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Lyon |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Madison |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
McCreary |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
McLean |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Meade |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Menifee |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Mercer |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Montgomery |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Muhlenberg |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Nelson |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Nicholas |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Ohio |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Oldham |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Owen |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Owsley |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Pendleton |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Powell |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Pulaski |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Robertson |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Rockcastle |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Scott |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Shelby |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Spencer |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Todd |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Trigg |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Trimble |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Union |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Washington |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Wayne |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Webster |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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Gateway Health Medicare Assured Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Wolfe |
$97.00 |
$250 |
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: 27% 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 Platinum (HMO SNP) in KY - H9190-016-0
Benefit Details
|
Woodford |
$97.00 |
$250 |
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: 27% Select Care Drugs: $11.00
| n/a Browse Formulary |
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