IV BUSULFEX 6MG 1 X 10ML VIALGL (1 X 10ML VIALGL) (NDC: 59148007090)
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PPO HD Rx (PPO)
![Email Prescription and/or Health Benefit details for FreedomBlue PPO HD Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Open Value Plan w/Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Open Value Plan w/Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Open Value Plan w/Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Open Value Plan w/Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Open Value Plan w/Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,000.81 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Open Value Plan w/Rx (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,000.81 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 150](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 51 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
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 |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
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 |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
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 |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
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 |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
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 |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
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 |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
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 |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
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 |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
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 |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
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 |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
![Email Prescription and/or Health Benefit details for FreedomBlue PFFS Choice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-099 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
FreedomBlue PPO Basic Rx (PPO)
![Email Prescription and/or Health Benefit details for FreedomBlue PPO Basic Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,010.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-101 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-101 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-101 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,000.81 |
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 |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,000.81 |
Browse Plan Formulary |
FreedomBlue PPO Standard (PPO)
![Email Prescription and/or Health Benefit details for FreedomBlue PPO Standard (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,010.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-077 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-077 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
![Email Prescription and/or Health Benefit details for SecurityChoice Plus (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $866.88 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,012.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-074 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-100 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-100 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-100 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-100 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-100 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-100 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-100 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.90 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
Plan Name |
Monthly 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 MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan MP (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,036.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-076 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-076 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-076 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-076 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-076 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-076 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-076 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,000.81 |
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 |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,000.81 |
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 |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,000.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,000.81 |
Browse Plan Formulary |
HumanaChoice R5826-081 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-081 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $990.46 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Unison Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $1,036.32 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
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 |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
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 |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
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 |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
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 |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Community Living (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Life Specialty Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
![Email Prescription and/or Health Benefit details for UPMC for Life Specialty Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.10 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $270.00 | None | $855.00 |
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 |
Humana Gold Choice H2944-075 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-075 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-075 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-075 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-075 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-075 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-075 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-075 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-075 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-075 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-075 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-075 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-075 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-075 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
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 |
Humana Gold Choice H2944-075 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-075 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-075 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-075 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $990.46 |
Browse Plan Formulary |
HumanaChoice R5826-002 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-002 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.70 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $990.46 |
Browse Plan Formulary |
FreedomBlue PPO Deluxe (PPO)
![Email Prescription and/or Health Benefit details for FreedomBlue PPO Deluxe (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$51.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $1,010.83 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
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 |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
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 |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
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 |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
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 |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
![Email Prescription and/or Health Benefit details for UPMC for Life PPO Rx Enhanced (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $855.00 |
Browse Plan Formulary |