ARCALYST INJECTION 220MG/VIAL (4 VIALSD CRTN) (NDC: 61755000101)
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 |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-044 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
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 H2944-044 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-044 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-044 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-044 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-044 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $21,582.50 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $21,582.50 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $21,582.50 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $21,582.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $21,582.50 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $21,582.50 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $21,582.50 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $21,582.50 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $21,582.50 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $21,582.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $21,582.50 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
![Email Prescription and/or Health Benefit details for Fidelis Secure at Home (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $21,582.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
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 H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-047 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-051 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-051 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option A (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,840.60 |
Browse Plan Formulary |
HumanaChoice H5470-004 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5470-004 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,240.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Molina Medicare Options (HMO)
![Email Prescription and/or Health Benefit details for Molina Medicare Options (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $21,902.70 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
![Email Prescription and/or Health Benefit details for Molina Medicare Options (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $21,902.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
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 H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
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 H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
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 H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
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 H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
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 H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
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 H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
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 H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
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 H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
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 H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-049 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-006 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
HumanaChoice R5826-072 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-072 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $20,626.40 |
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 H2944-046 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-046 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-046 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-046 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-046 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-046 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-046 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
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 H2944-046 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-046 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $20,626.40 |
Browse Plan Formulary |
Healthy Advantage (HMO)
![Email Prescription and/or Health Benefit details for Healthy Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $21,902.70 |
Browse Plan Formulary |
Healthy Advantage (HMO)
![Email Prescription and/or Health Benefit details for Healthy Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $21,902.70 |
Browse Plan Formulary |
Healthy Advantage (HMO)
![Email Prescription and/or Health Benefit details for Healthy Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $21,902.70 |
Browse Plan Formulary |
Healthy Advantage (HMO)
![Email Prescription and/or Health Benefit details for Healthy Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $21,902.70 |
Browse Plan Formulary |
Healthy Advantage (HMO)
![Email Prescription and/or Health Benefit details for Healthy Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $21,902.70 |
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 |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $21,189.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $21,189.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $21,189.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $21,189.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $21,189.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $21,189.20 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue Option B (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $20,812.90 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $21,189.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $21,189.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $21,189.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $21,189.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $21,189.20 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $17,920.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $21,189.20 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
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 |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
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 |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
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 |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
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 |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.70 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.70 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $21,262.70 |
Browse Plan Formulary |