Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Arkansas |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Ashley |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Baxter |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Benton |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Boone |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Bradley |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Calhoun |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Carroll |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Chicot |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Clark |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Clay |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Cleburne |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Cleveland |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Columbia |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Conway |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Craighead |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Crawford |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Crittenden |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Cross |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Dallas |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Desha |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Drew |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Faulkner |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Franklin |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Fulton |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Garland |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Grant |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Greene |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Hempstead |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Hot Spring |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Howard |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Independence |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Izard |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Jackson |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Jefferson |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Johnson |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Lafayette |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Lawrence |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Lee |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Lincoln |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Little River |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Logan |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Lonoke |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Madison |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Marion |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Miller |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Mississippi |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Monroe |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Montgomery |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Nevada |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Newton |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Ouachita |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Perry |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
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Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Phillips |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| 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 |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Pike |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Poinsett |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Polk |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Pope |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Prairie |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Pulaski |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Randolph |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Saline |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Scott |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Searcy |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Sebastian |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Sevier |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Sharp |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
St. Francis |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Stone |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Union |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Van Buren |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Washington |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
White |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Woodruff |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in AR - R3444-009-0
Benefit Details
|
Yell |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Adair |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Andrew |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Atchison |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Audrain |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Barry |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Barton |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Bates |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Benton |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Bollinger |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Boone |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Buchanan |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Butler |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Caldwell |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Callaway |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Camden |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Cape Girardeau |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Carroll |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Carter |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Cass |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Cedar |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Chariton |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Christian |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Clark |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Clay |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Clinton |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Cole |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Cooper |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Crawford |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Dade |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Dallas |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Daviess |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
DeKalb |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Dent |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Douglas |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Dunklin |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
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Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Franklin |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Gasconade |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
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|
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Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Gentry |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
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|
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Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Greene |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Grundy |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
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Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Harrison |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
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Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Henry |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Hickory |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
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|
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Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Holt |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
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Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Howard |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Howell |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
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Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Iron |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Jackson |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Jasper |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Jefferson |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Johnson |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Knox |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Laclede |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Lafayette |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Lawrence |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Lewis |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Lincoln |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Linn |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Livingston |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Macon |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Madison |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Maries |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Marion |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
McDonald |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Mercer |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Miller |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Mississippi |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Moniteau |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Monroe |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Montgomery |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Morgan |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
New Madrid |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Newton |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Nodaway |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Oregon |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Osage |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Ozark |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Pemiscot |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Perry |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Pettis |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Phelps |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Pike |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Platte |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Polk |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Pulaski |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Putnam |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Ralls |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Randolph |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Ray |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
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Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Reynolds |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Ripley |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
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Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Saline |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Schuyler |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Scotland |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Scott |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Shannon |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Shelby |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
St. Charles |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
St. Clair |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
St. Francois |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
St. Louis |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
St. Louis City |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Ste. Genevieve |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Stoddard |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Stone |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Sullivan |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Taney |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Texas |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Vernon |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Warren |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Washington |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Wayne |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Webster |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Worth |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Care Improvement Plus Gold Rx (Regional PPO SNP) in MO - R3444-009-0
Benefit Details
|
Wright |
$19.00 |
$270 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Generic: $12.00 Preferred Brand: $46.00 Non-Preferred Brand: $100.00 Specialty Tier: 27%
| n/a Browse Formulary |
|
|
|
|