Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Adair |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Adams |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Audubon |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Buena Vista |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Calhoun |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Carroll |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Cherokee |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Dickinson |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Emmet |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Harrison |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Humboldt |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Ida |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Louisa |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Lyon |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Madison |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Pocahontas |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Sac |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Sioux |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Union |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Van Buren |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Washington |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in IA - H8145-089-0
Benefit Details
|
Webster |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Blue Earth |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Brown |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Dodge |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Faribault |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Fillmore |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Freeborn |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Goodhue |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Houston |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Jackson |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Martin |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Mower |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Nicollet |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Olmsted |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Redwood |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Rice |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Sibley |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Steele |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Wabasha |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Waseca |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MN - H8145-089-0
Benefit Details
|
Winona |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in MT - H8145-089-0
Benefit Details
|
Carbon |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MT - H8145-089-0
Benefit Details
|
Cascade |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MT - H8145-089-0
Benefit Details
|
Chouteau |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in MT - H8145-089-0
Benefit Details
|
Deer Lodge |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MT - H8145-089-0
Benefit Details
|
Flathead |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MT - H8145-089-0
Benefit Details
|
Judith Basin |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in MT - H8145-089-0
Benefit Details
|
Lincoln |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MT - H8145-089-0
Benefit Details
|
Pondera |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MT - H8145-089-0
Benefit Details
|
Ravalli |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in MT - H8145-089-0
Benefit Details
|
Rosebud |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MT - H8145-089-0
Benefit Details
|
Silver Bow |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in MT - H8145-089-0
Benefit Details
|
Teton |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in ND - H8145-089-0
Benefit Details
|
Burleigh |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in SD - H8145-089-0
Benefit Details
|
Bon Homme |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in SD - H8145-089-0
Benefit Details
|
Codington |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in SD - H8145-089-0
Benefit Details
|
Davison |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in SD - H8145-089-0
Benefit Details
|
Deuel |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in SD - H8145-089-0
Benefit Details
|
Hanson |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in SD - H8145-089-0
Benefit Details
|
Pennington |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in SD - H8145-089-0
Benefit Details
|
Spink |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in SD - H8145-089-0
Benefit Details
|
Turner |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-089 (PFFS) in SD - H8145-089-0
Benefit Details
|
Union |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-089 (PFFS) in SD - H8145-089-0
Benefit Details
|
Yankton |
$97.00 |
$399 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $11.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|