Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-1
Benefits & Contact Info
|
Allegan |
$184.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-1
Benefits & Contact Info
|
Barry |
$184.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-1
Benefits & Contact Info
|
Ionia |
$184.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-1
Benefits & Contact Info
|
Kalamazoo |
$184.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-1
Benefits & Contact Info
|
Mason |
$184.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-1
Benefits & Contact Info
|
Muskegon |
$184.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-1
Benefits & Contact Info
|
Newaygo |
$184.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-1
Benefits & Contact Info
|
Oceana |
$184.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-1
Benefits & Contact Info
|
Ottawa |
$184.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-2
Benefits & Contact Info
|
Berrien |
$246.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-2
Benefits & Contact Info
|
Branch |
$246.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-2
Benefits & Contact Info
|
Calhoun |
$246.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-2
Benefits & Contact Info
|
Eaton |
$246.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-2
Benefits & Contact Info
|
Gratiot |
$246.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-2
Benefits & Contact Info
|
Hillsdale |
$246.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-2
Benefits & Contact Info
|
Ingham |
$246.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-2
Benefits & Contact Info
|
Jackson |
$246.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-2
Benefits & Contact Info
|
Monroe |
$246.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-2
Benefits & Contact Info
|
Montcalm |
$246.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-2
Benefits & Contact Info
|
St. Joseph |
$246.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-2
Benefits & Contact Info
|
Van Buren |
$246.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Alcona |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Alger |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Alpena |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Arenac |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Baraga |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Bay |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Charlevoix |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Cheboygan |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Chippewa |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Clare |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Crawford |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Gladwin |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Huron |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Iosco |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Kalkaska |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Keweenaw |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Luce |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Mackinac |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Montmorency |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Ogemaw |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Ontonagon |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Oscoda |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Presque Isle |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Roscommon |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Saginaw |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Sanilac |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Schoolcraft |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Shiawassee |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-3
Benefits & Contact Info
|
Tuscola |
$284.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Antrim |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Benzie |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Cass |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Clinton |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Delta |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Dickinson |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Emmet |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Genesee |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Gogebic |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Grand Traverse |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Houghton |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Iron |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Isabella |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Kent |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Lake |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Lapeer |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Leelanau |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Lenawee |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Livingston |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Manistee |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Marquette |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Mecosta |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Menominee |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Midland |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Missaukee |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Osceola |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Otsego |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
St. Clair |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-4
Benefits & Contact Info
|
Wexford |
$216.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-6
Benefits & Contact Info
|
Macomb |
$283.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-6
Benefits & Contact Info
|
Oakland |
$283.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 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 |
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-6
Benefits & Contact Info
|
Washtenaw |
$283.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Medicare Plus Blue PPO Assure (PPO) in MI - H9572-003-6
Benefits & Contact Info
|
Wayne |
$283.00 |
$0 |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $37.00 Non-Preferred Drug: 45% Specialty Tier: 33%
all covered insulin pay $35 or less | $3,425 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|