HEPARIN SODIUM INJECTION USP 5000UNITS 25 X 10ML VIALMD (25 X 10 ML VIALMD) (NDC: 63323004710)
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 Balance (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $413.93 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $413.93 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $413.93 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $413.93 |
Browse Plan Formulary |
AARP MedicareComplete Mosaic (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $413.83 |
Browse Plan Formulary |
Plan Name |
Monthly 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 1 (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $413.79 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $413.79 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $413.96 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $413.96 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $413.96 |
Browse Plan Formulary |
AARP MedicareComplete Plan 4 (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | None | $413.91 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 4 (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $16.00 | None | $413.91 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | $50.00 | None | $436.15 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | None | $408.24 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | None | $408.24 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | None | $408.24 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | None | $408.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | None | $408.24 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$3.00 | $6.00 | None | $408.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $302.94 |
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 |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $306.71 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $306.71 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $306.71 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $306.71 |
Browse Plan Formulary |
Elderplan Classic II: Medicare Zero Premiu
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $306.46 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $306.46 |
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 |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $306.46 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $306.46 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $306.46 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $306.46 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $413.91 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $413.91 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $413.91 |
Browse Plan Formulary |
Fidelis Medicare Advantage (HMO-POS)
|
$0.00 |
$310* |
to be determined |
1* |
Tier 1 |
$4.00 | $8.00 | None | $434.74 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
$5.00 | $15.00 | None | $434.74 |
Browse Plan Formulary |
GHI Medicare PPO Any Dual (PPO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $392.40 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $436.68 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $436.68 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $436.68 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $436.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $436.68 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $436.68 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $299.01 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $299.01 |
Browse Plan Formulary |
Healthfirst 65 Plus Plan (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $434.78 |
Browse Plan Formulary |
Healthfirst Medicare Plus Plan (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $434.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $436.68 |
Browse Plan Formulary |
HIP VIP (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $382.76 |
Browse Plan Formulary |
HIP VIP (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $438.43 |
Browse Plan Formulary |
HIP VIP Dual Eligible (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $401.30 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $436.68 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $386.73 |
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 |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $436.68 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $386.73 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $436.68 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $386.73 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $436.68 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $386.73 |
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 |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $436.68 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $386.73 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $436.68 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $386.73 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $436.68 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $386.73 |
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 |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $436.68 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
40% | 40% | P | $386.73 |
Browse Plan Formulary |
Liberty Health Advantage Preferred Choice
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
$50.00 | $150.00 | P | $391.65 |
Browse Plan Formulary |
MediBlue Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $432.97 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $432.97 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $432.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $432.97 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $432.97 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $432.97 |
Browse Plan Formulary |
MediBlue Value (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $432.39 |
Browse Plan Formulary |
MetroPlus Platinum (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $400.84 |
Browse Plan Formulary |
SecureHorizons MedicareComplete Choice (Re
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.19 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.19 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.19 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.19 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.19 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.19 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.19 |
Browse Plan Formulary |
Touchstone Grand (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $408.12 |
Browse Plan Formulary |
Touchstone Health Medicare Freedom (HMO-PO
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $408.14 |
Browse Plan Formulary |
Touchstone Health Medicare Power (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $408.14 |
Browse Plan Formulary |
VNS CHOICE Medicare Option 5 (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $408.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MediBlue Plus (PPO)
|
$2.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $432.34 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $418.75 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $418.75 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $418.75 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.37 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.37 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $426.24 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$10.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $438.03 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $434.54 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $439.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $434.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $434.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $434.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $434.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $434.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $434.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $439.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $426.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.72 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $368.30 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $368.30 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $368.30 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $434.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $434.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $434.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $434.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $434.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $434.44 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.81 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.81 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $415.73 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $425.67 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $425.67 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $425.67 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $425.67 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $425.67 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $425.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $425.67 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $425.67 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$20.80 |
$0 |
to be determined |
2 |
Tier 2 |
$33.00 | $66.00 | None | $415.90 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$20.80 |
$0 |
to be determined |
2 |
Tier 2 |
$33.00 | $66.00 | None | $415.90 |
Browse Plan Formulary |
Humana Gold Choice H4774-004 (PFFS)
|
$20.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,416.50 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $436.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $382.76 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $438.43 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $436.68 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $382.76 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $438.43 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $436.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $382.76 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $438.43 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $436.68 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $382.76 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $438.43 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $436.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $382.76 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $438.43 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $436.68 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $382.76 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $438.43 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $436.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $382.76 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $438.43 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $436.68 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $382.76 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $438.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.92 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $403.89 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $382.82 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $382.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $382.82 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $382.82 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $382.82 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $382.82 |
Browse Plan Formulary |
Evercare Plan RMP (Regional PPO)
|
$23.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $415.89 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $439.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan DH (HMO)
|
$24.80 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.79 |
Browse Plan Formulary |
Evercare Plan DH-U (HMO)
|
$24.80 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.79 |
Browse Plan Formulary |
Evercare Plan DH-U (HMO)
|
$24.80 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.79 |
Browse Plan Formulary |
Evercare Plan DH-U (HMO)
|
$24.80 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.79 |
Browse Plan Formulary |
Evercare Plan DH-U (HMO)
|
$24.80 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.79 |
Browse Plan Formulary |
Evercare Plan DH-U (HMO)
|
$24.80 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan RDP (Regional PPO)
|
$24.80 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $415.89 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
MetroPlus Advantage Plan (HMO)
|
$26.50 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $400.84 |
Browse Plan Formulary |
MetroPlus Medicare Partnership in Care Pla
|
$26.50 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $400.84 |
Browse Plan Formulary |
MetroPlus Select Plan (HMO)
|
$26.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $400.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Standard Plan (PPO)
|
$27.60 |
$0 |
to be determined |
2 |
Tier 2 |
$27.00 | $54.00 | None | $415.90 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$27.60 |
$0 |
to be determined |
2 |
Tier 2 |
$27.00 | $54.00 | None | $415.90 |
Browse Plan Formulary |
Evercare Plan IH (HMO)
|
$27.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $416.08 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$28.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $436.68 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $439.77 |
Browse Plan Formulary |
Evercare Plan IH (HMO)
|
$29.30 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $416.08 |
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 |
Humana Gold Choice H4774-003 (PFFS)
|
$29.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,416.50 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $1,022.93 |
Browse Plan Formulary |
Elderplan Medicare Extra Help (HMO)
|
$30.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $306.46 |
Browse Plan Formulary |
Elderplan Medicare For Medicaid Beneficiar
|
$30.60 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $306.46 |
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 |
Elderplan Medicare For Nursing Home Reside
|
$30.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $306.46 |
Browse Plan Formulary |
Elderplan Medicare Plus Managed Long Term
|
$30.60 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $306.46 |
Browse Plan Formulary |
Elderplan Medicare Plus Medicaid Advantage
|
$30.60 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $306.46 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $963.53 |
Browse Plan Formulary |
Elderplan Medicare Premium Benefit (HMO-PO
|
$31.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $306.46 |
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 |
GHI Medicare PPO III (PPO)
|
$31.40 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $438.03 |
Browse Plan Formulary |
VNS CHOICE Medicare Option 1 (HMO)
|
$31.60 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $408.24 |
Browse Plan Formulary |
VNS CHOICE Medicare Option 2 (HMO)
|
$31.60 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $408.24 |
Browse Plan Formulary |
ArchCare - Institutional Equiv SNP - NYC (
|
$32.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $408.24 |
Browse Plan Formulary |
ArchCare - Institutional Equiv SNP - NYC (
|
$32.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $408.24 |
Browse Plan Formulary |
ArchCare - Institutional Equiv SNP - NYC (
|
$32.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $408.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
ArchCare - Institutional SNP - NYC (HMO)
|
$32.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $408.24 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
Healthfirst Increased Benefits Plan (HMO)
|
$33.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $434.78 |
Browse Plan Formulary |
Healthfirst Increased Benefits Plan (HMO)
|
$33.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $434.78 |
Browse Plan Formulary |
Healthfirst Life Improvement Plan (HMO)
|
$33.00 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $434.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Healthfirst Maximum Plan (HMO)
|
$33.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $434.78 |
Browse Plan Formulary |
Affinity Medicare Solutions (HMO)
|
$33.30 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $434.75 |
Browse Plan Formulary |
Affinity Medicare Ultimate (HMO)
|
$33.30 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $434.75 |
Browse Plan Formulary |
Fidelis Dual Advantage (HMO)
|
$33.30 |
$310 |
to be determined |
1 |
Tier 1 |
0% | 0% | None | $434.74 |
Browse Plan Formulary |
Fidelis Dual Advantage Flex Plan (HMO)
|
$33.30 |
$310* |
to be determined |
1* |
Tier 1 |
$0.00 | $0.00 | None | $431.39 |
Browse Plan Formulary |
Fidelis Medicare Advantage Flex Plan (HMO-
|
$33.30 |
$310 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | None | $431.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GuildNet Gold (HMO-POS)
|
$33.30 |
$310 |
to be determined |
3 |
Tier 3 |
$95.00 | $285.00 | P | $438.33 |
Browse Plan Formulary |
Health Plus Elite - Dual Special Needs Pla
|
$33.30 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $408.57 |
Browse Plan Formulary |
Health Plus Elite - MAPD (HMO)
|
$33.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $408.57 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $20.00 | None | $447.78 |
Browse Plan Formulary |
Northeast Community Care - Enhanced (HMO)
|
$33.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $409.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Northeast Community Care - Enhanced (HMO)
|
$33.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $409.02 |
Browse Plan Formulary |
Northeast Community Care - Enhanced (HMO)
|
$33.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $409.02 |
Browse Plan Formulary |
Touchstone Health Medicare Prestige (HMO)
|
$33.30 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $408.14 |
Browse Plan Formulary |
Touchstone Health Medicare Total (HMO)
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $408.14 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $358.38 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $358.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $358.38 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $358.38 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $358.38 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $415.90 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$34.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $415.90 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $425.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $425.67 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $425.67 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $425.67 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $425.67 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $425.67 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $425.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $425.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $426.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $434.54 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $415.90 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $415.90 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $377.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$43.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $377.00 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $436.15 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $436.15 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $368.30 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $368.30 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 50% | P | $368.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $449.73 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $449.73 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $449.73 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $449.73 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $449.73 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $449.73 |
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 |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $449.73 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $449.73 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $429.98 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $429.98 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $429.98 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $449.73 |
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 |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $449.73 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $449.73 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $449.73 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $449.73 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $449.73 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $449.73 |
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 |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $449.73 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$54.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $415.90 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$54.30 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $415.90 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $429.98 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $429.98 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $429.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
MediBlue Plus (PPO)
|
$70.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $433.19 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
VNS CHOICE Managed Long Term Care Plus (HM
|
$83.40 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $408.24 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $480.12 |
Browse Plan Formulary |