PEG-INTRON REDIPEN PAK 4 (120 MCG/0.5ML 4PAK CTR) (NDC: 00085129702)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,227.72 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,227.72 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,227.72 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,227.72 |
Browse Plan Formulary |
AARP MedicareComplete Mosaic (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,227.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,227.36 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,227.36 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,227.73 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,227.73 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,227.73 |
Browse Plan Formulary |
AARP MedicareComplete Plan 4 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,225.30 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 4 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,225.30 |
Browse Plan Formulary |
Advantage Silver NY (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,222.36 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,240.95 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,240.95 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,240.95 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,240.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,240.95 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,240.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $2,308.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $2,281.02 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $2,281.02 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $2,281.02 |
Browse Plan Formulary |
Elderplan Classic I: Medicare Extra Needs
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $2,281.02 |
Browse Plan Formulary |
Elderplan Classic II: Medicare Zero Premiu
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $2,282.11 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,282.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,282.11 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,282.11 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,282.11 |
Browse Plan Formulary |
Elderplan Medicare Part B Premium Reductio
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,282.11 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,224.42 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,224.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,224.42 |
Browse Plan Formulary |
Fidelis Medicare Advantage (HMO-POS)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
GHI Medicare PPO Any Dual (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,257.18 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
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 |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,284.48 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,284.48 |
Browse Plan Formulary |
Healthfirst 65 Plus Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:5 /34Days | $2,276.71 |
Browse Plan Formulary |
Healthfirst Jade Benefits Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:5 /34Days | $2,272.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Healthfirst Medicare Plus Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:5 /34Days | $2,330.57 |
Browse Plan Formulary |
HIP VIP (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,264.23 |
Browse Plan Formulary |
HIP VIP Dual Eligible (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,256.30 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
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 |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,261.07 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,261.07 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,261.07 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
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 |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,261.07 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,261.07 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,261.07 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
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 |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,261.07 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,261.07 |
Browse Plan Formulary |
Liberty Health Advantage Preferred Choice
|
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
25% | n/a | P Q:4 /28Days | $2,447.97 |
Browse Plan Formulary |
MediBlue Plus (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.32 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.32 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.32 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.32 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,316.32 |
Browse Plan Formulary |
MediBlue Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,337.52 |
Browse Plan Formulary |
MetroPlus Platinum (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,327.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareComplete Choice (Re
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,226.93 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,282.34 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,282.34 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,282.34 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,282.34 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,282.34 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,282.34 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,282.34 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,282.34 |
Browse Plan Formulary |
Touchstone Health Medicare Freedom (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:12 /90Days | $2,224.56 |
Browse Plan Formulary |
Touchstone Health Medicare Power (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:12 /90Days | $2,224.56 |
Browse Plan Formulary |
VNS CHOICE Medicare Option 5 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,240.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MediBlue Plus (PPO)
|
$2.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,313.78 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /30Days | $2,240.15 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /30Days | $2,240.15 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /30Days | $2,240.15 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.40 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.40 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$9.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,339.60 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$10.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /28Days | $2,267.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,263.31 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,339.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,256.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,256.99 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,256.99 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,256.99 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,256.99 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,256.99 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,339.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
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 |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,278.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,297.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /28Days | $2,279.37 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /28Days | $2,279.37 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /28Days | $2,279.37 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,256.99 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,256.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,256.99 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,256.99 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,256.99 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,256.99 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,223.43 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,223.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $2,223.43 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | $2,226.67 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
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 |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
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 |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,260.83 |
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 |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /30Days | $2,256.47 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /30Days | $2,256.47 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /30Days | $2,256.47 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /30Days | $2,256.47 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /30Days | $2,256.47 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /30Days | $2,252.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /30Days | $2,252.49 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /30Days | $2,252.49 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$20.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,235.00 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$20.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,235.00 |
Browse Plan Formulary |
Humana Gold Choice H4774-004 (PFFS)
|
$20.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,227.74 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
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 |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,264.23 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,264.23 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
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 |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,264.23 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,264.23 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
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 |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,264.23 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,264.23 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
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 |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,264.23 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,264.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,295.93 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,328.47 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,265.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,265.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,265.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,265.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,265.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,265.24 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$23.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,203.80 |
Browse Plan Formulary |
Evercare Plan RMP (Regional PPO)
|
$23.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,226.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,339.60 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$24.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,203.80 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $2,294.61 |
Browse Plan Formulary |
MetroPlus Advantage Plan (HMO)
|
$26.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $2,327.65 |
Browse Plan Formulary |
MetroPlus Medicare Partnership in Care Pla
|
$26.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $2,327.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MetroPlus Select Plan (HMO)
|
$26.50 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $2,327.65 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$27.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,235.00 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$27.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,235.00 |
Browse Plan Formulary |
Evercare Plan IH (HMO)
|
$27.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,225.84 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$28.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,339.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$29.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,225.84 |
Browse Plan Formulary |
Humana Gold Choice H4774-003 (PFFS)
|
$29.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,227.74 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,223.55 |
Browse Plan Formulary |
Elderplan Medicare Extra Help (HMO)
|
$30.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,282.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Elderplan Medicare For Nursing Home Reside
|
$30.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,282.11 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,222.79 |
Browse Plan Formulary |
Elderplan Medicare Premium Benefit (HMO-PO
|
$31.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $2,282.11 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$31.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /28Days | $2,267.56 |
Browse Plan Formulary |
ArchCare - Institutional Equiv SNP - NYC (
|
$32.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $2,240.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
ArchCare - Institutional Equiv SNP - NYC (
|
$32.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $2,240.95 |
Browse Plan Formulary |
ArchCare - Institutional SNP - NYC (HMO)
|
$32.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $2,240.95 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
Healthfirst Increased Benefits Plan (HMO)
|
$33.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:5 /34Days | $2,280.51 |
Browse Plan Formulary |
Healthfirst Increased Benefits Plan (HMO)
|
$33.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:5 /34Days | $2,280.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Specialty + Rx (HMO)
|
$33.30 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,240.95 |
Browse Plan Formulary |
Fidelis Dual Advantage (HMO)
|
$33.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Fidelis Dual Advantage Flex Plan (HMO)
|
$33.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
Fidelis Medicare Advantage Flex Plan (HMO-
|
$33.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $2,334.82 |
Browse Plan Formulary |
GuildNet Gold (HMO-POS)
|
$33.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,253.83 |
Browse Plan Formulary |
Health Plus Elite - MAPD (HMO)
|
$33.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $2,235.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | P | $2,294.61 |
Browse Plan Formulary |
Northeast Community Care - Enhanced (HMO)
|
$33.30 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,240.97 |
Browse Plan Formulary |
Northeast Community Care - Enhanced (HMO)
|
$33.30 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,240.97 |
Browse Plan Formulary |
Northeast Community Care - Enhanced (HMO)
|
$33.30 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,240.97 |
Browse Plan Formulary |
Touchstone Health Medicare Total (HMO)
|
$33.30 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:12 /90Days | $2,224.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Standard Plan (HMO)
|
$34.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,203.80 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,197.41 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,197.41 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,197.41 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,197.41 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,197.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Select Plan (HMO)
|
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,235.00 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,235.00 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /30Days | $2,256.47 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /30Days | $2,256.47 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /30Days | $2,256.47 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /30Days | $2,256.47 |
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 |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /30Days | $2,256.47 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /30Days | $2,252.49 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /30Days | $2,252.49 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /30Days | $2,252.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,297.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,269.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,263.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Platinum NY (HMO)
|
$39.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,222.36 |
Browse Plan Formulary |
Advantage Platinum NY - Suffolk (HMO)
|
$41.20 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,225.82 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,235.00 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,235.00 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.20 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,210.74 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.20 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,210.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Health Suffolk - SNP (HMO)
|
$44.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,225.82 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$44.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,239.03 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$44.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,239.03 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /28Days | $2,279.37 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /28Days | $2,279.37 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /28Days | $2,279.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $2,291.77 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $2,291.77 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $2,291.77 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $2,291.77 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $2,291.77 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $2,291.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $2,291.77 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $2,291.77 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,203.80 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,203.80 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,203.80 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $2,291.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $2,291.77 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $2,291.77 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $2,291.77 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $2,291.77 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $2,291.77 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $2,291.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $2,291.77 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$54.30 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,235.00 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$54.30 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,235.00 |
Browse Plan Formulary |
Advantage Health NY - SNP (HMO)
|
$54.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,222.36 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,203.80 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,203.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$54.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,203.80 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
MediBlue Plus (PPO)
|
$70.20 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,394.24 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P Q:12 /90Days | $2,224.61 |
Browse Plan Formulary |