CHORIONIC GONAD 10000U VIAL (10 X 10 ML PKGCOM) (NDC: 63323002510)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $104.00 | P | $1,012.13 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Plan Name |
Monthly 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-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $1,012.13 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $1,012.13 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $1,012.13 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $1,012.13 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $1,012.13 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $1,012.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | P | $1,012.13 |
Browse Plan Formulary |
Humana Gold Plus H2486-002 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H2486-002 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
![Email Prescription and/or Health Benefit details for Molina Medicare Options (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | P | $1,017.52 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sierra Optima Select Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Select Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | P | $950.07 |
Browse Plan Formulary |
Sierra Optima Choice Rx (PFFS)
![Email Prescription and/or Health Benefit details for Sierra Optima Choice Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | n/a | P | $509.64 |
Browse Plan Formulary |
HumanaChoice H4606-001 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H4606-001 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-057 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-057 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-057 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-057 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-057 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-057 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-057 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-057 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-057 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-057 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-055 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-055 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan DH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $1,012.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-058 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-058 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-058 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-058 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-058 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-058 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-058 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-058 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-058 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-058 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-056 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-056 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,158.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Altius Advantra Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for Altius Advantra Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $21.00 | None | $945.21 |
Browse Plan Formulary |
Regence MedAdvantage + Rx Classic (PPO)
![Email Prescription and/or Health Benefit details for Regence MedAdvantage + Rx Classic (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.60 |
$200 |
to be determined |
4 |
Tier 4 |
27% | n/a | P | $970.91 |
Browse Plan Formulary |
Regence MedAdvantage + Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for Regence MedAdvantage + Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.30 |
$0 |
to be determined |
4 |
Tier 4 |
30% | n/a | P | $970.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Healthy Advantage (HMO)
![Email Prescription and/or Health Benefit details for Healthy Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.80 |
$310* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | P | $1,017.52 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
![Email Prescription and/or Health Benefit details for Molina Medicare Options Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.80 |
$310* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | P | $1,017.52 |
Browse Plan Formulary |