ANDROGEL 1%(50MG) GEL PACKET (3O X 5GM PKT CRTN) (NDC: 00051845030)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete Choice Plan 2 (Regio
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $259.86 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $259.83 |
Browse Plan Formulary |
Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | n/a | P Q:300 /30Days | $259.89 |
Browse Plan Formulary |
Advantage Choice POS (HMO-POS)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Advantage Health Florida (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | n/a | P Q:300 /30Days | $259.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plus POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | n/a |
Browse Plan Formulary |
Advantage Premium POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | None | n/a |
Browse Plan Formulary |
Advantage Silver - East (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | n/a | P Q:300 /30Days | $259.94 |
Browse Plan Formulary |
Advantra Gold (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $10.00 | P | $260.44 |
Browse Plan Formulary |
Advantra Gold (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | P | $260.11 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$5.00 | $10.00 | P | $251.12 |
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 |
CareFree (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.99 |
Browse Plan Formulary |
CareFree (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.98 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:300 /30Days | $256.99 |
Browse Plan Formulary |
CareOne (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | Q:300 /30Days | $257.59 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
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 |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
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 |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
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 |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $259.86 |
Browse Plan Formulary |
Humana Gold Plus H1036-047 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.43 |
Browse Plan Formulary |
Humana Gold Plus H1036-047 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.43 |
Browse Plan Formulary |
Humana Gold Plus H1036-047 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5426-001 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | Q:300 /30Days | $257.76 |
Browse Plan Formulary |
Humana Gold Plus H5426-008 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.65 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.65 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.65 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.65 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.65 |
Browse Plan Formulary |
Humana Gold Plus H5426-019 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.65 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Direct
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$20.00 | n/a | None | $270.02 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.74 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.65 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.73 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.73 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.73 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.73 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.73 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.73 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.73 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.65 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.71 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.71 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.71 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.71 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.71 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.68 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.68 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.68 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.68 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.65 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.74 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.74 |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | P | $262.74 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | P | $262.74 |
Browse Plan Formulary |
Medicare Masterpiece Premier (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | P | $262.74 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | Q:300 /30Days | $255.38 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | Q:300 /30Days | $255.38 |
Browse Plan Formulary |
Preferred Care Partners Preferred Freedom
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $262.48 |
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 |
Preferred Care Partners Preferred Freedom
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $262.48 |
Browse Plan Formulary |
Preferred Care Partners Preferred Freedom
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $262.48 |
Browse Plan Formulary |
Preferred Care Partners Preferred Freedom
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $262.48 |
Browse Plan Formulary |
Preferred Care Partners Preferred Freedom
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $262.48 |
Browse Plan Formulary |
Preferred Care Partners Senior Health Choi
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $40.00 | None | $262.53 |
Browse Plan Formulary |
PUP Easy (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $80.00 | P | $259.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PUP Rewards (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $110.00 | P | $259.79 |
Browse Plan Formulary |
Summit Ideal (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | P | $260.17 |
Browse Plan Formulary |
Summit Ideal (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | P | $260.56 |
Browse Plan Formulary |
Summit Maximum (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P | $260.20 |
Browse Plan Formulary |
Summit Maximum (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P | $260.20 |
Browse Plan Formulary |
Summit Maximum (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P | $260.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Summit Plus (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P | $260.20 |
Browse Plan Formulary |
Value One Florida (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | n/a | P Q:300 /30Days | $259.82 |
Browse Plan Formulary |
VISTA Platinum Choice (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P | $260.23 |
Browse Plan Formulary |
VISTA Platinum Choice (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $80.00 | P | $260.23 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.65 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.65 |
Browse Plan Formulary |
Humana Gold Plus H5426-002 (HMO-POS)
|
$0.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.65 |
Browse Plan Formulary |
Universal IP (HMO)
|
$1.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $262.74 |
Browse Plan Formulary |
Universal IP (HMO)
|
$1.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $262.74 |
Browse Plan Formulary |
Universal IP (HMO)
|
$1.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $262.74 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.77 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.77 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.77 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.77 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.92 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.92 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.92 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.92 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.92 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.92 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.96 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.92 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.92 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.92 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.92 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.92 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.92 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$18.30 |
$0 |
to be determined |
3 |
Tier 3 |
$37.00 | $74.00 | None | $259.37 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$18.30 |
$0 |
to be determined |
3 |
Tier 3 |
$37.00 | $74.00 | None | $259.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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 RDP (Regional PPO)
|
$19.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $259.86 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$19.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | Q:300 /30Days | $255.38 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$19.70 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | Q:300 /30Days | $255.38 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
|
$19.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $259.76 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
|
$19.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $259.76 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
|
$19.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $259.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan DH (HMO)
|
$19.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $259.76 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
|
$19.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $259.76 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $266.34 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.70 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.70 |
Browse Plan Formulary |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.70 |
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 |
BlueMedicare HMO (HMO)
|
$21.00 |
$105 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.70 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
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 |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
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 |
Medicare Masterpiece (PPO)
|
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | P Q:300 /30Days | $279.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $266.34 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $263.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $263.92 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | $87.50 | None | $263.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $263.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $263.92 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | $87.50 | None | $263.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $264.85 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $267.04 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $267.04 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $267.04 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H5426-013 (HMO)
|
$22.60 |
$310 |
to be determined |
2 |
Tier 2 |
$37.00 | $92.50 | Q:300 /30Days | $257.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $60.00 | P | $262.77 |
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 |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-138 (PFFS)
|
$24.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-139 (PFFS)
|
$24.60 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.38 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-141 (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.40 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
|
$28.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | Q:300 /30Days | $257.35 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.71 |
Browse Plan Formulary |
Medicare Masterpiece (PPO)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Masterpiece (PPO)
|
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.71 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$30.30 |
$0 |
to be determined |
3 |
Tier 3 |
$37.00 | $74.00 | None | $259.37 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$30.30 |
$0 |
to be determined |
3 |
Tier 3 |
$37.00 | $74.00 | None | $259.37 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
|
$32.70 |
$90 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-140 (PFFS)
|
$33.50 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $95.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice R5826-005 (Regional PPO)
|
$35.80 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | Q:300 /30Days | $257.35 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$36.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | None | $259.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-142 (PFFS)
|
$37.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $256.81 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
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 |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece Premier (PPO)
|
$37.60 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
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 |
Humana Gold Choice H2944-143 (PFFS)
|
$38.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.38 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$39.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $260.17 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$39.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $260.17 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$39.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $253.34 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$39.30 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $105.00 | None | $253.34 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$46.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $258.86 |
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 |
Aetna Medicare Premier Plan (HMO)
|
$46.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $258.86 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$46.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $258.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-144 (PFFS)
|
$48.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | Q:300 /30Days | $257.37 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
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 |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - COPD (PPO)
|
$49.40 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
BlueMedicare PFFS (PFFS)
|
$49.50 |
$145 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | None | $259.61 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
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 |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
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 |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Diabetes (PPO)
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$54.40 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $258.86 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$54.40 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $258.86 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$54.40 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $258.86 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
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 |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
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 |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |
Medicare Masterpiece SNP - Dementia (PPO)
|
$63.10 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | P | $262.70 |
Browse Plan Formulary |