MAXIPIME 1G VIAL (10 X 1 GM/15 ML BOX) (NDC: 51479005430)
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
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 |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $193.63 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$4.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.43 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.30 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.24 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | $193.82 |
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 | $193.82 |
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 | $193.82 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.40 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.28 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.67 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.67 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.67 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.67 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.67 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.67 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.67 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.67 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.67 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.67 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.67 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.10 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.67 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
![Email Prescription and/or Health Benefit details for Geisinger Gold Open 3 $0 Deductible Rx (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.50 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.17 |
Browse Plan Formulary |
Plan Name |
Monthly 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 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 | $193.63 |
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 | None | $190.76 |
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 | None | $190.76 |
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 | $193.63 |
Browse Plan Formulary |
SeniorBlue - Option 2 (HMO)
![Email Prescription and/or Health Benefit details for SeniorBlue - Option 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.50 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $196.62 |
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 | None | $190.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-077 (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 | None | $190.76 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
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 | $198.20 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $197.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $208.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $208.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $208.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $208.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $208.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $192.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $192.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $192.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $192.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $192.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $208.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $208.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $208.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $208.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $208.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $192.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $192.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $192.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $192.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $192.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $198.81 |
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 | None | $187.75 |
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 | None | $187.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
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 | None | $187.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $186.41 |
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 | None | $186.41 |
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 | None | $186.41 |
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 | None | $186.41 |
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 | None | $186.41 |
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 | None | $186.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | None | $193.24 |
Browse Plan Formulary |
SeniorBlue - Option 2 (PPO)
![Email Prescription and/or Health Benefit details for SeniorBlue - Option 2 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.80 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $197.26 |
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 | None | $186.41 |
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 | None | $186.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | None | $186.41 |
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 | None | $186.41 |
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 | None | $186.41 |
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 | None | $186.41 |
Browse Plan Formulary |
SeniorBlue - Option 1 (HMO)
![Email Prescription and/or Health Benefit details for SeniorBlue - Option 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $196.62 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $200.69 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $200.69 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $190.06 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $190.06 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $190.06 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $190.06 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $200.69 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $200.69 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $190.06 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $190.06 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $190.06 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $190.06 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 Standard Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.12 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.12 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.12 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.12 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.12 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.12 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.12 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.12 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $192.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.20 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.20 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.20 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.20 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred Standard Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $189.20 |
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% | None | $187.00 |
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 |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $190.06 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $190.06 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $190.06 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $190.06 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 1 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $200.69 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $200.69 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $189.36 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.15 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $190.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $190.06 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $190.06 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 2 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $190.06 |
Browse Plan Formulary |
Geisinger Gold Classic 3 $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Classic 3 $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $188.71 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.12 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.12 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.12 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.12 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.12 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.12 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.12 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
![Email Prescription and/or Health Benefit details for Geisinger Gold Preferred $0 Deductible Rx](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $192.12 |
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 | None | $190.11 |
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 | None | $190.11 |
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 | None | $190.11 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $190.11 |
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 | None | $190.11 |
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 | None | $190.11 |
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 | None | $190.11 |
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 | None | $190.11 |
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 | None | $190.11 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | None | $190.11 |
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 | None | $190.11 |
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 | None | $190.11 |
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 | None | $190.11 |
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 | None | $190.11 |
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 | None | $190.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 | None | $187.00 |
Browse Plan Formulary |
SeniorBlue - Option 1 (PPO)
![Email Prescription and/or Health Benefit details for SeniorBlue - Option 1 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.60 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $197.26 |
Browse Plan Formulary |
Geisinger Gold Secure 3 (HMO)
![Email Prescription and/or Health Benefit details for Geisinger Gold Secure 3 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$46.00 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $97.50 | None | $186.26 |
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 | $193.63 |
Browse Plan Formulary |