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 |
Arcadian Health Plan - Plus (HMO)
![Email Prescription and/or Health Benefit details for Arcadian Health Plan - Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | n/a |
Browse Plan Formulary |
Arcadian Health Plan - Plus (HMO)
![Email Prescription and/or Health Benefit details for Arcadian Health Plan - Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | n/a |
Browse Plan Formulary |
Arcadian Health Plan - Plus (HMO)
![Email Prescription and/or Health Benefit details for Arcadian Health Plan - Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | n/a |
Browse Plan Formulary |
Arcadian Health Plan - Plus (HMO)
![Email Prescription and/or Health Benefit details for Arcadian Health Plan - Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | n/a |
Browse Plan Formulary |
Arcadian Health Plan - Plus (HMO)
![Email Prescription and/or Health Benefit details for Arcadian Health Plan - Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | None | 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 |
Evercare Plan MH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan MH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan MH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan MH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan MH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan MH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan MH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$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 MH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan MH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,774.49 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
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)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
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)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
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)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
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)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
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)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
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)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
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)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,482.21 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$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 H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$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 H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$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 H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$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 H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$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 H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$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 H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$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 H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$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 H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$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 H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$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 H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$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 H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$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 H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-023 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.20 |
$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 H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$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 H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$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 H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$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 H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-022 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$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 H2944-021 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-021 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-021 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-021 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-021 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-021 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-021 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$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 H2944-021 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-021 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-021 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-021 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-021 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-021 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-021 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$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 H2944-021 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-021 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-021 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $1,695.94 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 30% | P | $1,473.78 |
Browse Plan Formulary |