ANCOBON 500MG CAPSULE (100 BOT) (NDC: 00187355510)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.92 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.92 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.92 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.92 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.85 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,237.85 |
Browse Plan Formulary |
AARP MedicareComplete Plan 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,232.55 |
Browse Plan Formulary |
AARP MedicareComplete Plan 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,232.55 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$20.00 | $40.00 | None | $1,247.48 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$20.00 | $40.00 | None | $1,247.48 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$20.00 | $40.00 | None | $1,247.48 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$20.00 | $40.00 | None | $1,247.48 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$20.00 | $40.00 | None | $1,247.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,225.50 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,278.15 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,278.15 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,278.15 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,278.15 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,252.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,252.39 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,252.39 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,252.39 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,252.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,240.01 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,240.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,240.01 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | None | $1,299.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,271.54 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,271.54 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,271.54 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,271.54 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,271.54 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,258.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,258.34 |
Browse Plan Formulary |
Healthfirst Medicare Plus Plan (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,062.41 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,271.54 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,271.54 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,258.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,271.54 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,271.54 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,271.54 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,258.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,271.54 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,271.54 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,271.54 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,258.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MediBlue Value (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,290.16 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,290.16 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,290.16 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,290.16 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,290.16 |
Browse Plan Formulary |
SecureHorizons MedicareComplete Choice (Re
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,235.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Medicare Blue Choice Value (HMO)
|
$5.40 |
$150 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
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 |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$10.00 |
$0 | to be determined | 2 |
Tier 2 |
$20.00 | $40.00 | None | $1,258.34 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,266.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,256.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,256.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | None | $1,256.51 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 | to be determined | 2 |
Tier 2 |
$20.00 | $40.00 | None | $1,258.34 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 | to be determined | 2 |
Tier 2 |
$20.00 | $40.00 | None | $1,258.34 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 | to be determined | 2 |
Tier 2 |
$20.00 | $40.00 | None | $1,258.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | None | $1,234.70 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | None | $1,234.70 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | None | $1,234.70 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $225.00 | None | $1,130.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,254.11 |
Browse Plan Formulary |
Medicare Blue PPO - Plan 201 (PPO)
|
$18.00 |
$150 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
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 |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$20.80 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,245.35 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$20.80 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,245.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-004 (PFFS)
|
$20.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Medicare Blue Choice Value Plus (HMO)
|
$21.00 |
$150 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,271.54 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,271.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,271.54 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,271.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,271.54 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,271.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,271.54 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,271.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,258.34 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $50.00 | None | $1,258.34 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,331.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,285.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,260.03 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,260.03 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,260.03 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,260.03 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,260.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,260.03 |
Browse Plan Formulary |
Evercare Plan RMP (Regional PPO)
|
$23.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,235.29 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | None | $1,279.86 |
Browse Plan Formulary |
Blue Choice Senior (Cost)
|
$26.30 |
$110 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $902.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Standard Plan (PPO)
|
$27.60 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,245.35 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$27.60 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,245.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
Humana Gold Choice H4774-003 (PFFS)
|
$29.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,130.90 |
Browse Plan Formulary |
Medicare Blue Choice Optimum (HMO)
|
$30.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,130.90 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$31.40 |
$0 | to be determined | 2 |
Tier 2 |
$20.00 | $40.00 | None | $1,258.34 |
Browse Plan Formulary |
ArchCare - Institutional Equiv SNP - NYC (
|
$32.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,247.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
ArchCare - Institutional Equiv SNP - NYC (
|
$32.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,247.48 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
Healthfirst Increased Benefits Plan (HMO)
|
$33.00 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,271.36 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $1,279.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Northeast Community Care - Enhanced (HMO)
|
$33.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,231.14 |
Browse Plan Formulary |
Northeast Community Care - Enhanced (HMO)
|
$33.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,231.14 |
Browse Plan Formulary |
Northeast Community Care - Enhanced (HMO)
|
$33.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,231.14 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,245.35 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,245.35 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,245.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,245.35 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,245.35 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$34.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,245.35 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$34.40 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,245.35 |
Browse Plan Formulary |
Preferred Gold Rx (HMO)
|
$36.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $170.00 | None | $1,257.29 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
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 |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
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 |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $1,254.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,266.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,256.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,256.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,256.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,302.77 |
Browse Plan Formulary |
GoldValue Rx (HMO)
|
$38.70 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $170.00 | None | $1,257.29 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Advantage Platinum NY - Suffolk (HMO)
|
$41.20 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | n/a | None | $1,289.44 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,245.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$43.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,245.35 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,245.35 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,245.35 |
Browse Plan Formulary |
Advantage Health Suffolk - SNP (HMO)
|
$44.30 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | n/a | None | $1,289.44 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$44.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,244.07 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$44.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,244.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,312.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,310.04 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,287.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 | to be determined | 2 |
Tier 2 |
$20.00 | $40.00 | None | $1,258.34 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 | to be determined | 2 |
Tier 2 |
$20.00 | $40.00 | None | $1,258.34 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 | to be determined | 2 |
Tier 2 |
$20.00 | $40.00 | None | $1,258.34 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $1,243.83 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $1,243.83 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $1,243.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $1,243.83 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $1,243.83 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $1,243.83 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $1,243.83 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $1,243.83 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,237.00 |
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 |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,237.00 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,237.00 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $1,243.49 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $1,243.49 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $1,243.49 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $1,243.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $1,243.49 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $1,243.49 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $1,243.49 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $1,243.49 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$54.30 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,245.35 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$54.30 |
$0 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,245.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,237.00 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,237.00 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,237.00 |
Browse Plan Formulary |
GoldAnywhere Rx (PPO)
|
$60.90 |
$0 | to be determined | 3 |
Tier 3 |
$90.00 | $180.00 | None | $1,257.29 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MediBlue Plus (PPO)
|
$70.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | None | $1,078.62 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $62.50 | None | $1,322.32 |
Browse Plan Formulary |