ABRAXANE 100MG VIAL (1 X 100 MG VIALSD) (NDC: 68817013450)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $971.17 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $971.17 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $971.17 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $971.17 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $971.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $971.17 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $971.17 |
Browse Plan Formulary |
AARP MedicareComplete Plan 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $969.00 |
Browse Plan Formulary |
AARP MedicareComplete Plan 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $969.00 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $919.92 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $981.18 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $981.18 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $981.18 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $981.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $981.18 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $981.18 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $981.18 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $981.18 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $981.18 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $968.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $968.51 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $968.51 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $992.65 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $992.65 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $992.65 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $992.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $992.65 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $983.70 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $983.70 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $992.65 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $992.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $992.65 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $992.65 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $992.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $992.65 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $992.65 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $992.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | P | $980.63 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,042.18 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,042.18 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,042.18 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,042.18 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,042.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareComplete Choice (Re
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $970.87 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $980.63 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $980.63 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $980.63 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$10.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P | $968.33 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P | $968.33 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | P | $968.33 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $980.63 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $980.63 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $980.63 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $980.63 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $980.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $980.63 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $980.63 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $980.63 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$20.80 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $944.58 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$20.80 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $944.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-004 (PFFS)
|
$20.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $992.65 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $992.65 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $992.65 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $992.65 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $992.65 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $992.65 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $992.65 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $992.65 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,015.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $964.71 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $985.21 |
Browse Plan Formulary |
Evercare Plan RMP (Regional PPO)
|
$23.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $970.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$27.60 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $944.58 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$27.60 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $944.58 |
Browse Plan Formulary |
Humana Gold Choice H4774-003 (PFFS)
|
$29.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $963.65 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$31.40 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,006.05 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $973.73 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $973.73 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $973.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $973.73 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $973.73 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$34.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $944.58 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$34.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $944.58 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $980.63 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $980.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $980.63 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $980.63 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $980.63 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $980.63 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $980.63 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $980.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GoldAnywhere Rx (PPO)
|
$40.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $932.43 |
Browse Plan Formulary |
Advantage Platinum NY - Suffolk (HMO)
|
$41.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $969.49 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $944.58 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $944.58 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $973.73 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $973.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Health Suffolk - SNP (HMO)
|
$44.30 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $969.49 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$44.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $972.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$44.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $972.72 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | P | $980.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $972.47 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $972.47 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $972.47 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $972.47 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $972.47 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $972.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $972.47 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $972.47 |
Browse Plan Formulary |
Preferred Gold Rx (HMO)
|
$47.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $932.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $979.25 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $979.25 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $979.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $972.21 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $972.21 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $972.21 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $972.21 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $972.21 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $972.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $972.21 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $972.21 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$54.30 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $944.58 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$54.30 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $944.58 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $979.25 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $979.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $979.25 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
MediBlue Plus (PPO)
|
$70.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,042.18 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 3 |
Tier 3 |
50% | 42% | None | $911.42 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $100.00 | None | $911.42 |
Browse Plan Formulary |