AMBISOME 50MG VIAL (20 CC VIALSU) (NDC: 00469305130)
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 |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
Plan Name |
Monthly 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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
Plan Name |
Monthly 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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
Plan Name |
Monthly 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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
Plan Name |
Monthly 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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
Plan Name |
Monthly 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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
Plan Name |
Monthly 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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
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) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,678.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPlus MedicarePlus - AdvantageHMO Opt
![Email Prescription and/or Health Benefit details for HealthPlus MedicarePlus - AdvantageHMO Opt](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$9.30 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | P | $1,671.06 |
Browse Plan Formulary |
BCN Advantage (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$13.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
BCN Advantage (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$13.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
BCN Advantage (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$13.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
BCN Advantage (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$13.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
BCN Advantage (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$13.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-044 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-044 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-044 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-044 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-044 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-044 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
HealthPlus MedicarePlus - AdvantageHMO Opt
![Email Prescription and/or Health Benefit details for HealthPlus MedicarePlus - AdvantageHMO Opt](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | P | $1,671.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HAP Senior Plus - Expanded Network (HMO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus - Expanded Network (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.20 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,600.80 |
Browse Plan Formulary |
Alliance Medicare PPO (PPO)
![Email Prescription and/or Health Benefit details for Alliance Medicare PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,600.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-051 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-051 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,634.43 |
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 |
HumanaChoice H5470-004 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5470-004 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,620.56 |
Browse Plan Formulary |
HAP Senior Plus - Expanded Network (HMO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus - Expanded Network (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.10 |
$110 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,600.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-006 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
HumanaChoice R5826-072 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-072 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-046 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-046 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-046 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-046 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-046 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-046 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-046 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-046 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-046 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,620.56 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,665.24 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,408.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,696.72 |
Browse Plan Formulary |
BCN Advantage (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$58.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
BCN Advantage (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$58.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
BCN Advantage (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$58.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
BCN Advantage (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$58.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
BCN Advantage (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$58.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | n/a | P | $1,633.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Alliance Medicare PPO (PPO)
![Email Prescription and/or Health Benefit details for Alliance Medicare PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$70.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,600.80 |
Browse Plan Formulary |