Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Adams |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Allen |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Ashtabula |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Auglaize |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Brown |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Butler |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Carroll |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Champaign |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Clark |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Clermont |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Clinton |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Columbiana |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Crawford |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Cuyahoga |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Darke |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Fayette |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Fulton |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Gallia |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Geauga |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Greene |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Hamilton |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Hardin |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Harrison |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Henry |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Highland |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Hocking |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Holmes |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Jackson |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Jefferson |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Lake |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Lawrence |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Licking |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Logan |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Lorain |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Lucas |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Madison |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Mahoning |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Medina |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Mercer |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Miami |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Monroe |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Montgomery |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Morrow |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Noble |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Ottawa |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Paulding |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Perry |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Pickaway |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Pike |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Portage |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Preble |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Putnam |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Shelby |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Stark |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Summit |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Trumbull |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Van Wert |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Vinton |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|
Gateway Health Medicare Assured Prime (HMO) in OH - H9190-006-0
Benefit Details
|
Warren |
$92.00 |
$250 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 28%
| $6,700 Browse Formulary |
|
|
|
|