AMIFOSTINE FOR INJECTION 500MG/VIAL (3 X 10ML VIALSU) (NDC: 62756058142)
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
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 | None | $1,275.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,444.00 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,354.69 |
Browse Plan Formulary |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
25% | 25% | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
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 |
4 |
Tier 4 |
33% | n/a | None | $1,803.12 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
![Email Prescription and/or Health Benefit details for Great Lakes Personal Care Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.90 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | P | $1,326.30 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
![Email Prescription and/or Health Benefit details for Great Lakes Personal Care Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.90 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | P | $1,326.30 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
![Email Prescription and/or Health Benefit details for Great Lakes Personal Care Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.90 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | P | $1,326.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,347.82 |
Browse Plan Formulary |