ACTONEL 5MG TABLET (30 TABLETS BOT) (NDC: 00149047101)
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
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:31 /31Days | $114.37 |
Browse Plan Formulary |
Advantage Choice POS (HMO-POS)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Advantage Plus POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$20.00 | $40.00 | None | n/a |
Browse Plan Formulary |
Advantage Premium POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | n/a |
Browse Plan Formulary |
Advantra Gold (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $135.00 | S Q:30 /30Days | $114.46 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$50.00 | $150.00 | S Q:30 /30Days | $114.32 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.48 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.23 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $87.50 | Q:30 /30Days | $106.48 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.74 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.74 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.74 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.74 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.74 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.74 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.74 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.74 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.74 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.74 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.74 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.74 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.74 |
Browse Plan Formulary |
Citrus Platinum Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.74 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.74 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $120.58 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
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 |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
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 |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.76 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.76 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.76 |
Browse Plan Formulary |
Citrus Saver (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $123.76 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
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 |
CitrusCare (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
CitrusCare (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | S Q:30 /30Days | $121.32 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
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)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
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)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
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)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:31 /31Days | $114.38 |
Browse Plan Formulary |
Humana Gold Plus H1036-047 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.32 |
Browse Plan Formulary |
Humana Gold Plus H1036-047 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.32 |
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 |
Humana Gold Plus H1036-047 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.32 |
Browse Plan Formulary |
Humana Gold Plus H1036-081D (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.90 |
Browse Plan Formulary |
Humana Gold Plus H5426-008 (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.10 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.10 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.10 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.10 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.10 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.10 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.10 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Direct
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$5.00 | n/a | Q:30 /30Days | $119.10 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.67 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.58 |
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)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.71 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.71 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.71 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.71 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.71 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.71 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.71 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.71 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.58 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.64 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.64 |
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 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.77 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.58 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.58 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.58 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.76 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.76 |
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)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.76 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.76 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.76 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.58 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.90 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.90 |
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)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.90 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$50.00 | $100.00 | S | $115.79 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$50.00 | $100.00 | S | $115.79 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$50.00 | $100.00 | S | $115.79 |
Browse Plan Formulary |
Molina Medicare Options Broward (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $30.00 | None | $114.59 |
Browse Plan Formulary |
Molina Medicare SmartSaver (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $30.00 | None | $114.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | S Q:30 /30Days | $117.90 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | S Q:30 /30Days | $117.90 |
Browse Plan Formulary |
PUP Easy (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $80.00 | Q:31 /31Days | $114.33 |
Browse Plan Formulary |
PUP Rewards (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $110.00 | Q:31 /31Days | $114.30 |
Browse Plan Formulary |
Summit Ideal (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | S Q:30 /30Days | $114.26 |
Browse Plan Formulary |
Summit Maximum (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$76.00 | $228.00 | S Q:30 /30Days | $114.27 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$76.00 | $228.00 | S Q:30 /30Days | $114.27 |
Browse Plan Formulary |
Summit Maximum (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$76.00 | $228.00 | S Q:30 /30Days | $114.27 |
Browse Plan Formulary |
Summit Plus (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$77.00 | $231.00 | S Q:30 /30Days | $114.47 |
Browse Plan Formulary |
VISTA Platinum Choice (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$77.00 | $231.00 | S Q:30 /30Days | $114.34 |
Browse Plan Formulary |
VISTA Platinum Choice (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$77.00 | $231.00 | S Q:30 /30Days | $114.34 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.10 |
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)
|
$0.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.10 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.10 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.10 |
Browse Plan Formulary |
Universal IP (HMO)
|
$1.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | S | $115.79 |
Browse Plan Formulary |
Universal IP (HMO)
|
$1.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | S | $115.79 |
Browse Plan Formulary |
Universal IP (HMO)
|
$1.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | S | $115.79 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
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)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
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)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
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)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
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)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
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)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
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)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.72 |
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)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
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)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
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)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
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)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
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)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
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)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
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)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
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)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
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)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
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)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
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)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.86 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.75 |
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)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.75 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.75 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$18.30 |
$0 | to be determined | 3 |
Tier 3 |
$37.00 | $74.00 | None | $114.84 |
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)
|
$18.30 |
$0 | to be determined | 3 |
Tier 3 |
$37.00 | $74.00 | None | $114.84 |
Browse Plan Formulary |
Evercare Plan RDP (Regional PPO)
|
$19.00 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $114.37 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$19.70 |
$0 | to be determined | 2 |
Tier 2 |
$15.00 | $30.00 | S Q:30 /30Days | $117.90 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$19.70 |
$0 | to be determined | 2 |
Tier 2 |
$15.00 | $30.00 | S Q:30 /30Days | $117.90 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
|
$19.90 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $114.39 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
|
$19.90 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $114.39 |
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)
|
$19.90 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $114.39 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
|
$19.90 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $114.39 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
|
$19.90 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | Q:31 /31Days | $114.39 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.91 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.91 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.91 |
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)
|
$21.00 |
$105 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.91 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
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)
|
$21.50 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
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)
|
$21.50 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.75 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:30 /30Days | $122.85 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.72 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.72 |
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)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.46 |
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)
|
$24.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.46 |
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)
|
$24.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-139 (PFFS)
|
$24.60 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | Q:30 /30Days | $106.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.84 |
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)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.84 |
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)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.84 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$28.00 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $106.88 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$29.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.58 |
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)
|
$29.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.58 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$29.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.58 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$37.00 | $74.00 | None | $114.84 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$37.00 | $74.00 | None | $114.84 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$32.70 |
$90 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
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)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
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)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
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)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
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)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
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)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
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)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
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)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
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)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$35.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:30 /30Days | $106.88 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
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)
|
$36.80 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | None | $114.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
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)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
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)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
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)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $107.46 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.69 |
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)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.69 |
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)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $115.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-143 (PFFS)
|
$38.40 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.36 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$39.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $115.16 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$39.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $115.16 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$39.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $105.00 | Q:30 /30Days | $119.39 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$39.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $105.00 | Q:30 /30Days | $119.39 |
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)
|
$46.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $114.52 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$46.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $114.52 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$46.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $114.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
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)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
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)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
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)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
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)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
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)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
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)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:30 /30Days | $106.86 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
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)
|
$49.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
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)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
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)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
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)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
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)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
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)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
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)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
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)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
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)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
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)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
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)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
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)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 | to be determined | 3 |
Tier 3 |
$95.00 | $190.00 | S Q:30 /30Days | $114.58 |
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)
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
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)
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$54.40 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | None | $114.52 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$54.40 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | None | $114.52 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$54.40 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | None | $114.52 |
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 |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
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)
|
$63.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $115.69 |
Browse Plan Formulary |