CEFIZOX 1GM IN D5W 50ML (NDC: 00469722001)
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 |
Aetna Medicare Dual Advantage Plan (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $293.05 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $291.06 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $291.06 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $291.06 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $291.06 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $291.06 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $291.06 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $291.06 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $291.06 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $291.06 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $291.06 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $291.06 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $291.06 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $291.06 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | None | $291.06 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | None | $263.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $264.52 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $291.06 |
Browse Plan Formulary |
HumanaChoice R5826-012 (Regional PPO)
|
$13.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $296.46 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-017 (HMO)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-017 (HMO)
|
$25.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-019 (HMO)
|
$25.80 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $6,274.26 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $291.06 |
Browse Plan Formulary |
HumanaChoice H4520-001 (PPO)
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | None | $263.80 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | None | $263.80 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | None | $263.80 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | None | $263.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | None | $263.80 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
HumanaChoice R5826-075 (Regional PPO)
|
$33.10 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $6,274.26 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $293.05 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $293.05 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$43.10 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $293.05 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$43.10 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $293.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 |
to be determined |
4 |
Tier 4 |
$78.00 | $156.00 | None | $293.05 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 |
to be determined |
4 |
Tier 4 |
$78.00 | $156.00 | None | $293.05 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 |
to be determined |
4 |
Tier 4 |
$78.00 | $156.00 | None | $293.05 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 |
to be determined |
4 |
Tier 4 |
$78.00 | $156.00 | None | $293.05 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $291.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $291.06 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $291.06 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $259.19 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $259.19 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $259.19 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $259.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $259.19 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $259.19 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $259.19 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $259.19 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $259.19 |
Browse Plan Formulary |