ALKERAN FOR INJECTION 50MG/VIAL 1 VIALSU (1 VIALSU) (NDC: 00173013093)
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 |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$5.00 | $10.00 | None | n/a |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,706.10 |
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 |
Freedom Medicare Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,706.10 |
Browse Plan Formulary |
Freedom Savings Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,706.10 |
Browse Plan Formulary |
Freedom Savings Plan Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,706.10 |
Browse Plan Formulary |
Freedom VIP Care (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,706.10 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,706.10 |
Browse Plan Formulary |
Freedom VIP Savings (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,706.10 |
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 |
Freedom VIP Savings COPD (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | P | $1,706.10 |
Browse Plan Formulary |
Humana Gold Plus H1036-047 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Plus H1036-047 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Plus H1036-047 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Plus H5426-008 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Direct
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,747.35 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $100.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $100.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$50.00 | $100.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Molina Medicare Options Broward (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | n/a |
Browse Plan Formulary |
Molina Medicare SmartSaver (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | n/a |
Browse Plan Formulary |
Optimum Gold Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Gold Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Gold Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Gold Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
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 |
Optimum Gold Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Gold Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Gold Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Gold Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
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 |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
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 |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,706.10 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | P | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$70.00 | $195.00 | P | n/a |
Browse Plan Formulary |
PUP Easy (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | n/a |
Browse Plan Formulary |
PUP Rewards (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | n/a |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Universal IP (HMO)
|
$1.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,709.28 |
Browse Plan Formulary |
Universal IP (HMO)
|
$1.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,709.28 |
Browse Plan Formulary |
Universal IP (HMO)
|
$1.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$18.30 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$18.30 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,713.43 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Extra (HMO)
|
$19.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | P | n/a |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$19.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | P | n/a |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,733.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-139 (PFFS)
|
$24.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$28.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $1,695.94 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$29.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$29.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$29.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 (PPO)
|
$30.30 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$30.30 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,713.43 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$32.70 |
$90 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,713.43 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
5 |
Tier 5 |
33% | 33% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,713.43 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
|
$35.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
5 |
Tier 5 |
25% | 25% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,713.43 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
5 |
Tier 5 |
25% | 25% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,713.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $1,709.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-143 (PFFS)
|
$38.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$39.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,713.43 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$39.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,741.24 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$39.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,741.24 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$46.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$46.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,713.43 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
5 |
Tier 5 |
33% | 33% | P | $1,713.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $1,720.44 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$54.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$54.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,713.43 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$54.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,713.43 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $1,709.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $1,709.28 |
Browse Plan Formulary |