ELIGARD 30MG SYRINGE (NDC: 00024061030)
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 |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Preferred Ea](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Preferred Ea](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Preferred Ea](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Preferred Ea](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Preferred Ea
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Preferred Ea](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Preferred Ea](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Preferred Ea](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Preferred Ea](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Preferred Ea](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Preferred Ea](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Preferred Ea
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Preferred Ea](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
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 |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,719.48 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,803.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus Plan 2 (HMO-POS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,707.15 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus Plan 2 (HMO-POS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plus Plan 2 (HMO-POS
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus Plan 2 (HMO-POS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,707.15 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus Plan 2 (HMO-POS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,707.15 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus Plan 2 (HMO-POS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,707.15 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus Plan 2 (HMO-POS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,707.15 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus Plan 2 (HMO-POS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,707.15 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus Plan 2 (HMO-POS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$79.00 | $227.00 | None | $1,775.46 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,726.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,939.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,939.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,939.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,939.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,939.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,939.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,939.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,939.15 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,737.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,790.53 |
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 |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyLiving Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $1,727.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
HealthSpring TotalCare (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring TotalCare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.40 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $1,727.94 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-012 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-012 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,696.87 |
Browse Plan Formulary |
HumanaChoice H4408-001 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H4408-001 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,696.87 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Diamond (PPO)
![Email Prescription and/or Health Benefit details for BlueAdvantage Diamond (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,781.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Ruby (PPO)
![Email Prescription and/or Health Benefit details for BlueAdvantage Ruby (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,781.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option II (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,803.64 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,810.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $1,851.51 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,797.86 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,788.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
![Email Prescription and/or Health Benefit details for Sterling Option IV (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,803.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
![Email Prescription and/or Health Benefit details for HealthSpring HealthyAdvantage Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | P | $1,727.94 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,707.15 |
Browse Plan Formulary |