CLEOCIN HCL 300MG CAPSULE (100 BOT) (NDC: 00009039514)
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 |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $974.71 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $974.71 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $974.71 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $974.71 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $974.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $957.01 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $957.01 |
Browse Plan Formulary |
Healthfirst Medicare Plus Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $990.17 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $974.71 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $974.71 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $974.71 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $974.71 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $974.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $974.71 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $974.71 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $974.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | None | $957.01 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:84 /1Days | $991.51 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:84 /1Days | $991.51 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:84 /1Days | $991.51 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:84 /1Days | $991.51 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:84 /1Days | $991.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Choice Value (HMO)
|
$5.40 |
$150 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$10.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $960.01 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $940.45 |
Browse Plan Formulary |
Medicare Blue PPO - Plan 201 (PPO)
|
$18.00 |
$150 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Humana Gold Choice H4774-004 (PFFS)
|
$20.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Medicare Blue Choice Value Plus (HMO)
|
$21.00 |
$150 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $974.71 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $974.71 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $974.71 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $974.71 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $974.71 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $974.71 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $974.71 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $974.71 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,009.53 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Blue Choice Senior (Cost)
|
$26.30 |
$110 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $688.34 |
Browse Plan Formulary |
Humana Gold Choice H4774-003 (PFFS)
|
$29.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue Choice Optimum (HMO)
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $940.45 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$31.40 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $960.01 |
Browse Plan Formulary |
Healthfirst Increased Benefits Plan (HMO)
|
$33.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $990.17 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $979.48 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $957.02 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | None | $957.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $949.04 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $949.04 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $949.04 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $949.04 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $949.04 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $949.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $949.04 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $949.04 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $948.79 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $948.79 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $948.79 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $948.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $948.79 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $948.79 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $948.79 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $948.79 |
Browse Plan Formulary |
MediBlue Plus (PPO)
|
$70.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:84 /1Days | $823.12 |
Browse Plan Formulary |