MYLOTARG 5MG VIAL (5 MG VIALGL) (NDC: 00008451001)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete Balance (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Balance (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,793.38 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Balance (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,793.38 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Balance (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,793.38 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Balance (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,793.38 |
Browse Plan Formulary |
AARP MedicareComplete Mosaic (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Mosaic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,793.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,793.38 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,793.38 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 3 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,793.38 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 3 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,793.38 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 3 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,793.38 |
Browse Plan Formulary |
AARP MedicareComplete Plan 4 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 4 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,793.38 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 4 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 4 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,793.38 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,697.09 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
![Email Prescription and/or Health Benefit details for Elderplan Classic I: Medicare Extra Needs](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,547.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Elderplan Classic I: Medicare Extra Needs
![Email Prescription and/or Health Benefit details for Elderplan Classic I: Medicare Extra Needs](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,547.68 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
![Email Prescription and/or Health Benefit details for Elderplan Classic I: Medicare Extra Needs](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,547.68 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
![Email Prescription and/or Health Benefit details for Elderplan Classic I: Medicare Extra Needs](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,547.68 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
![Email Prescription and/or Health Benefit details for Elderplan Classic I: Medicare Extra Needs](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,547.68 |
Browse Plan Formulary |
Elderplan Classic II: Medicare Zero Premiu
![Email Prescription and/or Health Benefit details for Elderplan Classic II: Medicare Zero Premiu](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,547.68 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
![Email Prescription and/or Health Benefit details for Elderplan Medicare Part B Premium Reductio](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,547.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Elderplan Medicare Part B Premium Reductio
![Email Prescription and/or Health Benefit details for Elderplan Medicare Part B Premium Reductio](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,547.68 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
![Email Prescription and/or Health Benefit details for Elderplan Medicare Part B Premium Reductio](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,547.68 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
![Email Prescription and/or Health Benefit details for Elderplan Medicare Part B Premium Reductio](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,547.68 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
![Email Prescription and/or Health Benefit details for Elderplan Medicare Part B Premium Reductio](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,547.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan MH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,793.38 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan MH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,793.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan MH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,793.38 |
Browse Plan Formulary |
GHI Medicare PPO Any Dual (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO Any Dual (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO II (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,726.21 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO Value (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
HIP VIP Dual Eligible (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Dual Eligible (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Medicaid Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Medicaid Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Medicaid Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Medicaid Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Medicaid Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Medicaid Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Medicaid Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Medicaid Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Medicaid Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Medicaid Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Medicaid Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Medicaid Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Medicaid Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Medicaid Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Medicaid Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Medicaid Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Liberty Health Advantage Preferred Choice
![Email Prescription and/or Health Benefit details for Liberty Health Advantage Preferred Choice](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
25% | n/a | P | $2,738.03 |
Browse Plan Formulary |
MetroPlus Platinum (HMO)
![Email Prescription and/or Health Benefit details for MetroPlus Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $2,742.83 |
Browse Plan Formulary |
SecureHorizons MedicareComplete Choice (Re
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareComplete Choice (Re](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,685.88 |
Browse Plan Formulary |
Touchstone Health Medicare Freedom (HMO-PO
![Email Prescription and/or Health Benefit details for Touchstone Health Medicare Freedom (HMO-PO](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $100.00 | None | $2,715.78 |
Browse Plan Formulary |
Touchstone Health Medicare Power (HMO)
![Email Prescription and/or Health Benefit details for Touchstone Health Medicare Power (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $100.00 | None | $2,715.78 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO Plan ONE (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.50 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,715.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO Plan ONE (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO Plan ONE (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.50 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,715.87 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO Plan ONE (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$5.50 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,715.87 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO II (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,717.70 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO II (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$15.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,726.21 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO II (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$15.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,726.21 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO II (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$15.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,726.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Personal Care Plus (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Personal Care Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,793.38 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Personal Care Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,793.38 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Personal Care Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,793.38 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Personal Care Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.30 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | $2,793.38 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-002 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO Plan ONE (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO Plan ONE (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,715.87 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO Plan ONE (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,715.87 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO Plan ONE (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,715.87 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO Plan ONE (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,715.87 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO Plan ONE (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,715.87 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO Plan ONE (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.30 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,715.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO Plan ONE (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO Plan ONE (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.30 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,715.87 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO Plan ONE (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.30 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,715.87 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,741.81 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,741.81 |
Browse Plan Formulary |
Humana Gold Choice H4774-004 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-004 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
![Email Prescription and/or Health Benefit details for HIP VIP Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,717.70 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
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 |
4 |
Tier 4 |
33% | 33% | P | $2,728.85 |
Browse Plan Formulary |
Evercare Plan RMP (Regional PPO)
![Email Prescription and/or Health Benefit details for Evercare Plan RMP (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,685.88 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere (PFFS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
MetroPlus Advantage Plan (HMO)
![Email Prescription and/or Health Benefit details for MetroPlus Advantage Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,742.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MetroPlus Medicare Partnership in Care Pla
![Email Prescription and/or Health Benefit details for MetroPlus Medicare Partnership in Care Pla](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $2,742.83 |
Browse Plan Formulary |
MetroPlus Select Plan (HMO)
![Email Prescription and/or Health Benefit details for MetroPlus Select Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | $2,742.83 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,741.81 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,741.81 |
Browse Plan Formulary |
Evercare Plan IH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan IH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,685.88 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO III (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,726.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan IH (HMO)
![Email Prescription and/or Health Benefit details for Evercare Plan IH (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,685.88 |
Browse Plan Formulary |
Humana Gold Choice H4774-003 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-003 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-005 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,669.69 |
Browse Plan Formulary |
Elderplan Medicare Extra Help (HMO)
![Email Prescription and/or Health Benefit details for Elderplan Medicare Extra Help (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,547.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Elderplan Medicare For Nursing Home Reside
![Email Prescription and/or Health Benefit details for Elderplan Medicare For Nursing Home Reside](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,547.68 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H4774-001 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,669.69 |
Browse Plan Formulary |
Elderplan Medicare Premium Benefit (HMO-PO
![Email Prescription and/or Health Benefit details for Elderplan Medicare Premium Benefit (HMO-PO](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,547.68 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO III (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,717.70 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Senior Blue HMO 652 P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Senior Blue HMO 652 P
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Senior Blue HMO 652 P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Senior Blue HMO 652 P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Senior Blue HMO 652 P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Senior Blue HMO 652 P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Senior Blue HMO 652 P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Senior Blue HMO 652 P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Senior Blue HMO 652 P
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Senior Blue HMO 652 P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
GuildNet Gold (HMO-POS)
![Email Prescription and/or Health Benefit details for GuildNet Gold (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,726.21 |
Browse Plan Formulary |
Health Plus Elite - Dual Special Needs Pla
![Email Prescription and/or Health Benefit details for Health Plus Elite - Dual Special Needs Pla](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,739.54 |
Browse Plan Formulary |
Health Plus Elite - MAPD (HMO)
![Email Prescription and/or Health Benefit details for Health Plus Elite - MAPD (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,739.54 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
![Email Prescription and/or Health Benefit details for Independent Health Medicare Anywhere Basic](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,427.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Touchstone Health Medicare Total (HMO)
![Email Prescription and/or Health Benefit details for Touchstone Health Medicare Total (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $100.00 | None | $2,715.78 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,697.09 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,697.09 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,697.09 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,697.09 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,697.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Select Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,741.81 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,741.81 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO - TWO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,715.87 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO - TWO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,715.87 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO - TWO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,715.87 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO - TWO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,715.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO - TWO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO - TWO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,715.87 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO - TWO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,715.87 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO - TWO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,715.87 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
![Email Prescription and/or Health Benefit details for Medicare Blue PPO - TWO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,715.87 |
Browse Plan Formulary |
Advantage Platinum NY - Suffolk (HMO)
![Email Prescription and/or Health Benefit details for Advantage Platinum NY - Suffolk (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.20 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,685.88 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,741.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,741.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,697.09 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,697.09 |
Browse Plan Formulary |
Advantage Health Suffolk - SNP (HMO)
![Email Prescription and/or Health Benefit details for Advantage Health Suffolk - SNP (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,685.88 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,697.09 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,697.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO III (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO III (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,726.21 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO III (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,726.21 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
![Email Prescription and/or Health Benefit details for GHI Medicare PPO III (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,726.21 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
![Email Prescription and/or Health Benefit details for Independent Health Medicare Passport (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,694.19 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
![Email Prescription and/or Health Benefit details for Independent Health Medicare Passport (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,694.19 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
![Email Prescription and/or Health Benefit details for Independent Health Medicare Passport (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,694.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Passport (PPO)
![Email Prescription and/or Health Benefit details for Independent Health Medicare Passport (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,694.19 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
![Email Prescription and/or Health Benefit details for Independent Health Medicare Passport (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,694.19 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
![Email Prescription and/or Health Benefit details for Independent Health Medicare Passport (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,694.19 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
![Email Prescription and/or Health Benefit details for Independent Health Medicare Passport (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,694.19 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
![Email Prescription and/or Health Benefit details for Independent Health Medicare Passport (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $2,694.19 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,697.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,697.09 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,697.09 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
![Email Prescription and/or Health Benefit details for Independent Health Encompass 65 Extra (HMO](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $2,693.47 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
![Email Prescription and/or Health Benefit details for Independent Health Encompass 65 Extra (HMO](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $2,693.47 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
![Email Prescription and/or Health Benefit details for Independent Health Encompass 65 Extra (HMO](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $2,693.47 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
![Email Prescription and/or Health Benefit details for Independent Health Encompass 65 Extra (HMO](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $2,693.47 |
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 |
Independent Health Encompass 65 Extra (HMO
![Email Prescription and/or Health Benefit details for Independent Health Encompass 65 Extra (HMO](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $2,693.47 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
![Email Prescription and/or Health Benefit details for Independent Health Encompass 65 Extra (HMO](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $2,693.47 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
![Email Prescription and/or Health Benefit details for Independent Health Encompass 65 Extra (HMO](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $2,693.47 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
![Email Prescription and/or Health Benefit details for Independent Health Encompass 65 Extra (HMO](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $2,693.47 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$54.30 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,741.81 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$54.30 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,741.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$54.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,697.09 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$54.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,697.09 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$54.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,697.09 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Forever Blue Medicare](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.50 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Forever Blue Medicare](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.50 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Forever Blue Medicare](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.50 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Forever Blue Medicare](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.50 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Forever Blue Medicare](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.50 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Forever Blue Medicare](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.50 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Forever Blue Medicare](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.50 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Forever Blue Medicare](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$69.50 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 752 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.60 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 752 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 752 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.60 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 752 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.60 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 752 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.60 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 752 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.60 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 752 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.60 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 752 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.60 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 752 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 752 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.60 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 752 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.60 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 752 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$73.60 |
$0 |
to be determined |
3 |
Tier 3 |
50% | 42% | None | $2,864.16 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 755 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$123.70 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 755 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$123.70 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 755 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$123.70 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 755 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 755 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$123.70 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 755 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$123.70 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 755 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$123.70 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 755 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$123.70 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 755 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$123.70 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 755 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$123.70 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 755 (
![Email Prescription and/or Health Benefit details for BlueShield Forever Blue Medicare PPO 755 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$123.70 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Forever Blue Medicare](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$157.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Forever Blue Medicare](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$157.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Forever Blue Medicare](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$157.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Forever Blue Medicare](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$157.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Forever Blue Medicare](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$157.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Forever Blue Medicare](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$157.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Forever Blue Medicare](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$157.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
![Email Prescription and/or Health Benefit details for BlueCross BlueShield Forever Blue Medicare](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$157.10 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $100.00 | None | $2,864.16 |
Browse Plan Formulary |