ACTONEL 30MG TABLET (30 BOT) (NDC: 00149047001)
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 Choice Plan 2 (Regio
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Choice Plan 2 (Regio](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $791.82 |
Browse Plan Formulary |
Advantage Choice POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Advantage Choice POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Advantage Plus POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Advantage Plus POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | None | n/a |
Browse Plan Formulary |
Advantage Premium POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Advantage Premium POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | n/a |
Browse Plan Formulary |
Advantra Gold (HMO)
![Email Prescription and/or Health Benefit details for Advantra Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $135.00 | S Q:30 /30Days | $795.36 |
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 |
Advantra Gold (HMO)
![Email Prescription and/or Health Benefit details for Advantra Gold (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | S Q:30 /30Days | $794.89 |
Browse Plan Formulary |
CareFree (HMO)
![Email Prescription and/or Health Benefit details for CareFree (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $739.75 |
Browse Plan Formulary |
CareFree (HMO)
![Email Prescription and/or Health Benefit details for CareFree (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $741.48 |
Browse Plan Formulary |
CareOne (HMO)
![Email Prescription and/or Health Benefit details for CareOne (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $87.50 | Q:30 /30Days | $739.75 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Platinum Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $849.11 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Platinum Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $849.11 |
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 |
Citrus Platinum Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Platinum Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $849.11 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Platinum Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $849.11 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Platinum Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $849.11 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Platinum Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $849.11 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Platinum Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $849.11 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Platinum Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $849.11 |
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 |
Citrus Platinum Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Platinum Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $849.11 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Platinum Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $849.11 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Platinum Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $849.11 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Platinum Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $849.11 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Platinum Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $849.11 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Platinum Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $849.11 |
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 |
Citrus Platinum Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Platinum Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $849.11 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $852.82 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
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 |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
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 |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $846.79 |
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 |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $846.79 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $846.79 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
![Email Prescription and/or Health Benefit details for Citrus Saver (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $846.79 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
![Email Prescription and/or Health Benefit details for CitrusCare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
![Email Prescription and/or Health Benefit details for CitrusCare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
![Email Prescription and/or Health Benefit details for CitrusCare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
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 |
CitrusCare (HMO-POS)
![Email Prescription and/or Health Benefit details for CitrusCare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
![Email Prescription and/or Health Benefit details for CitrusCare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
![Email Prescription and/or Health Benefit details for CitrusCare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
![Email Prescription and/or Health Benefit details for CitrusCare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
![Email Prescription and/or Health Benefit details for CitrusCare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $207.00 | S Q:5 /30Days | $827.18 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
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 MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
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 MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
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 MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $792.26 |
Browse Plan Formulary |
Humana Gold Plus H1036-047 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-047 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $742.45 |
Browse Plan Formulary |
Humana Gold Plus H1036-047 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-047 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $742.45 |
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 Plus H1036-047 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-047 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $742.45 |
Browse Plan Formulary |
Humana Gold Plus H5426-008 (HMO-POS)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5426-008 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.41 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5426-019 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.41 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5426-019 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.41 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5426-019 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.41 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5426-019 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.41 |
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 Plus H5426-019 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5426-019 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.41 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5426-019 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.41 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Direct
![Email Prescription and/or Health Benefit details for Medica HealthCare Plans MedicareMax Direct](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$5.00 | n/a | Q:30 /30Days | $822.87 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.27 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.36 |
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 Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.36 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.36 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.36 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.36 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.36 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.36 |
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 Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.36 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.36 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $799.64 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.12 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.12 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.61 |
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 Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $799.64 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $799.64 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $799.64 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $799.90 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $799.90 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $799.90 |
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 Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $799.90 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $799.90 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $799.64 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $802.87 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $802.87 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $802.87 |
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 |
Medicare Masterpiece Premier (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $100.00 | P | $800.58 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $100.00 | P | $800.58 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $100.00 | P | $800.58 |
Browse Plan Formulary |
Molina Medicare Options Broward (HMO)
![Email Prescription and/or Health Benefit details for Molina Medicare Options Broward (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $795.72 |
Browse Plan Formulary |
Molina Medicare SmartSaver (HMO)
![Email Prescription and/or Health Benefit details for Molina Medicare SmartSaver (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | None | $795.95 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
![Email Prescription and/or Health Benefit details for Physicians Health Choice Standard (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | S Q:30 /30Days | $810.23 |
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 |
Physicians Health Choice Standard (HMO)
![Email Prescription and/or Health Benefit details for Physicians Health Choice Standard (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | S Q:30 /30Days | $810.23 |
Browse Plan Formulary |
PUP Easy (HMO)
![Email Prescription and/or Health Benefit details for PUP Easy (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $80.00 | Q:31 /31Days | $791.45 |
Browse Plan Formulary |
PUP Rewards (HMO)
![Email Prescription and/or Health Benefit details for PUP Rewards (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $110.00 | Q:31 /31Days | $791.17 |
Browse Plan Formulary |
Summit Ideal (HMO)
![Email Prescription and/or Health Benefit details for Summit Ideal (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | S Q:30 /30Days | $792.42 |
Browse Plan Formulary |
Summit Maximum (HMO)
![Email Prescription and/or Health Benefit details for Summit Maximum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$76.00 | $228.00 | S Q:30 /30Days | $793.51 |
Browse Plan Formulary |
Summit Maximum (HMO)
![Email Prescription and/or Health Benefit details for Summit Maximum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$76.00 | $228.00 | S Q:30 /30Days | $793.51 |
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 |
Summit Maximum (HMO)
![Email Prescription and/or Health Benefit details for Summit Maximum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$76.00 | $228.00 | S Q:30 /30Days | $793.51 |
Browse Plan Formulary |
Summit Plus (HMO)
![Email Prescription and/or Health Benefit details for Summit Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$77.00 | $231.00 | S Q:30 /30Days | $794.32 |
Browse Plan Formulary |
VISTA Platinum Choice (HMO)
![Email Prescription and/or Health Benefit details for VISTA Platinum Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$77.00 | $231.00 | S Q:30 /30Days | $793.22 |
Browse Plan Formulary |
VISTA Platinum Choice (HMO)
![Email Prescription and/or Health Benefit details for VISTA Platinum Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$77.00 | $231.00 | S Q:30 /30Days | $793.22 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5426-002 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.41 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5426-002 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.41 |
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 Plus H5426-002 (HMO-POS)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5426-002 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.41 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5426-002 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.41 |
Browse Plan Formulary |
Universal IP (HMO)
![Email Prescription and/or Health Benefit details for Universal IP (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $800.58 |
Browse Plan Formulary |
Universal IP (HMO)
![Email Prescription and/or Health Benefit details for Universal IP (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $800.58 |
Browse Plan Formulary |
Universal IP (HMO)
![Email Prescription and/or Health Benefit details for Universal IP (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $800.58 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
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 |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
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 |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
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 |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
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 |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
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 |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
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 |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
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 |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.13 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.13 |
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 |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.13 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.13 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.52 |
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 |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
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 |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
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 |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
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 |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
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 |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
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 |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
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 |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
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 |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
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 |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
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 |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.52 |
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 |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.52 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.52 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.30 |
$0 |
to be determined |
3 |
Tier 3 |
$37.00 | $74.00 | None | $793.07 |
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 Value Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.30 |
$0 |
to be determined |
3 |
Tier 3 |
$37.00 | $74.00 | None | $793.07 |
Browse Plan Formulary |
Evercare Plan RDP (Regional PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan RDP (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $791.82 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
![Email Prescription and/or Health Benefit details for Physicians Health Choice Extra (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.70 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | S Q:30 /30Days | $810.23 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
![Email Prescription and/or Health Benefit details for Physicians Health Choice Extra (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.70 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | S Q:30 /30Days | $810.23 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan DH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $792.19 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan DH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $792.19 |
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 DH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan DH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $792.19 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan DH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $792.19 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan DH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $792.19 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$105 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $796.05 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$105 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $796.05 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$105 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $796.05 |
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 |
BlueMedicare HMO (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare HMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$105 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $796.05 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.56 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.56 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.56 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.56 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.56 |
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 Masterpiece (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.56 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.56 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.56 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.56 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.56 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.56 |
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 Masterpiece (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
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)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
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)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
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)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
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)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $847.32 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.13 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.13 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.13 |
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 |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $801.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-138 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-138 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-138 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-138 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-138 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $743.85 |
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 H2944-138 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-138 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-138 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-138 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-138 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-138 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-138 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $743.85 |
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 H2944-138 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-138 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-139 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-139 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.60 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:30 /30Days | $742.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-141 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $741.25 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-141 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $741.25 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-141 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $741.25 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-141 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $741.25 |
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 |
Humana Gold Choice H2944-141 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-141 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $741.25 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-141 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $741.25 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-141 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $741.25 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-141 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $741.25 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-141 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $741.25 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-141 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $741.25 |
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 |
Humana Gold Choice H2944-141 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-141 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $741.25 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-141 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $741.25 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-141 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $741.25 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-141 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $741.25 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-074 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $740.80 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $799.64 |
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 Masterpiece (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $799.64 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $799.64 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
3 |
Tier 3 |
$37.00 | $74.00 | None | $793.07 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
3 |
Tier 3 |
$37.00 | $74.00 | None | $793.07 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
![Email Prescription and/or Health Benefit details for BlueMedicare Regional PPO (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.70 |
$90 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
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)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
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)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
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 H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
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 H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
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 H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
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 H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
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 H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
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 H2944-140 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-140 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-005 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $740.80 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
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 Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $793.07 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
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 H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
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 H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
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 H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-142 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $743.85 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.34 |
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 Masterpiece Premier (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.34 |
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 Masterpiece Premier (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | P | $800.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-143 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-143 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.40 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $742.66 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $791.06 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $791.06 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | Q:30 /30Days | $791.40 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | Q:30 /30Days | $791.40 |
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)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$46.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $793.12 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$46.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $793.12 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$46.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $793.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
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 H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
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 H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
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 H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
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 H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
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 H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
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 H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-144 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $740.48 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - COPD (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - COPD (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - COPD (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - COPD (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
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 Masterpiece SNP - COPD (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - COPD (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - COPD (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - COPD (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - COPD (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - COPD (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
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 |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
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 |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
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 |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
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 |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
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 |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
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 |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
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 |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
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 |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
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 |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
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 |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
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 |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
![Email Prescription and/or Health Benefit details for BlueMedicare PFFS (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.50 |
$145 |
to be determined |
3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $793.62 |
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 Masterpiece SNP - Diabetes (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Diabetes (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Diabetes (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Diabetes (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Diabetes (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Diabetes (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Diabetes (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
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 Masterpiece SNP - Diabetes (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Diabetes (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Diabetes (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Diabetes (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$54.40 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $793.12 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$54.40 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $793.12 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$54.40 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $793.12 |
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 Masterpiece SNP - Dementia (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Dementia (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$63.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Dementia (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$63.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Dementia (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$63.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Dementia (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$63.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Dementia (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$63.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Dementia (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$63.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
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 Masterpiece SNP - Dementia (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Dementia (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$63.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Dementia (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$63.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece SNP - Dementia (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$63.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | P | $800.34 |
Browse Plan Formulary |