HECTOROL 4 MCG/2ML AMPUL (NDC: 58468012201)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$38.00 | $104.00 | None | $1,347.07 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Preferred Standard (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Preferred Standard (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Preferred Standard (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Preferred Standard (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network PlatinumSelect (PPO)
![Email Prescription and/or Health Benefit details for Network PlatinumSelect (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$26.00 | $68.00 | None | $1,121.79 |
Browse Plan Formulary |
UnitedHealthcare Personal Care Plus (HMO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Personal Care Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
UnitedHealthcare Personal Care Plus (HMO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Personal Care Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
UnitedHealthcare Personal Care Plus (HMO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Personal Care Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
UnitedHealthcare Personal Care Plus (HMO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Personal Care Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
UnitedHealthcare Personal Care Plus (HMO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Personal Care Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UnitedHealthcare Personal Care Plus (HMO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Personal Care Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
UnitedHealthcare Personal Care Plus (HMO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Personal Care Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
UnitedHealthcare Personal Care Plus (HMO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Personal Care Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
UnitedHealthcare Personal Care Plus (HMO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Personal Care Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
![Email Prescription and/or Health Benefit details for SmartValue Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,126.73 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-067 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-065 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-069 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-069 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
HumanaChoice H5216-008 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-008 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
HumanaChoice H5216-008 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-008 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan MH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $1,347.07 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-070 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-070 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-070 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-070 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-070 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-070 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-070 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-070 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-070 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-070 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Network PlatinumPlus Pharmacy (PPO)
![Email Prescription and/or Health Benefit details for Network PlatinumPlus Pharmacy (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.90 |
$0 |
to be determined |
3 |
Tier 3 |
$26.00 | $68.00 | None | $1,121.79 |
Browse Plan Formulary |
HumanaChoice H5216-003 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-003 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan DH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan DH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.20 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,347.07 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-066 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Evercare Plan IH-POS (HMO-POS)
![Email Prescription and/or Health Benefit details for Evercare Plan IH-POS (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,347.07 |
Browse Plan Formulary |
Network Cares (PPO)
![Email Prescription and/or Health Benefit details for Network Cares (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.20 |
$0 |
to be determined |
3 |
Tier 3 |
$0.00 | $0.00 | None | $1,121.79 |
Browse Plan Formulary |
Network PlatinumPremier Pharmacy (PPO)
![Email Prescription and/or Health Benefit details for Network PlatinumPremier Pharmacy (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.20 |
$0 |
to be determined |
3 |
Tier 3 |
$26.00 | $68.00 | None | $1,121.79 |
Browse Plan Formulary |