TOBRAMYCIN INHALATION SOLUTION (NDC: 00078049471)
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 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,254.00 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,254.59 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,254.59 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,254.59 |
Browse Plan Formulary |
AARP MedicareComplete Balance (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,254.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 3 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,254.37 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,254.37 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,254.37 |
Browse Plan Formulary |
AARP MedicareComplete Plan 4 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,249.33 |
Browse Plan Formulary |
AARP MedicareComplete Plan 4 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,249.33 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $4,284.42 |
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 |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $4,284.42 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $4,284.42 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $4,284.42 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $4,284.42 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,251.43 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,251.43 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,251.43 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
Fidelis Medicare Advantage Part B Reductio
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,463.88 |
Browse Plan Formulary |
GHI Medicare PPO Any Dual (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,312.03 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,502.15 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,502.15 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,404.62 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,404.62 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,404.62 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,404.62 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,404.62 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,404.62 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,404.62 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,404.62 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,576.76 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,576.76 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,576.76 |
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 |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,576.76 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,576.76 |
Browse Plan Formulary |
MediBlue Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,544.14 |
Browse Plan Formulary |
SecureHorizons MedicareComplete Choice (Re
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,274.72 |
Browse Plan Formulary |
MediBlue Select (HMO)
|
$2.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,563.94 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,261.32 |
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 |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,261.32 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,261.32 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$10.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $4,322.72 |
Browse Plan Formulary |
MediBlue Plus (PPO)
|
$12.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,498.33 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $4,416.83 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $4,416.83 |
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 II (PPO)
|
$15.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $4,416.83 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $4,416.83 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $4,250.22 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $4,250.22 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$16.30 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $4,250.22 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-002 (PFFS)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,306.03 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,306.03 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,306.03 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,306.03 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,306.03 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $4,306.03 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,306.03 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,306.03 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$20.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:8400 /28Days | $4,378.29 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$20.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:8400 /28Days | $4,378.29 |
Browse Plan Formulary |
Humana Gold Choice H4774-004 (PFFS)
|
$20.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,232.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,447.60 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,322.67 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,447.60 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,322.67 |
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 |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,447.60 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,322.67 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,447.60 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,322.67 |
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 |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,447.60 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,322.67 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,447.60 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,322.67 |
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 |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,447.60 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,322.67 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,309.06 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,447.60 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,322.67 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $4,543.05 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,543.05 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,415.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,831.24 |
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 | $4,831.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,831.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,831.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,831.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,831.24 |
Browse Plan Formulary |
Evercare Plan RMP (Regional PPO)
|
$23.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,274.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
|
$25.40 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:8400 /28Days | $4,491.61 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$27.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:8400 /28Days | $4,378.29 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$27.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:8400 /28Days | $4,378.29 |
Browse Plan Formulary |
Evercare Plan IH (HMO)
|
$27.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,257.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $4,257.45 |
Browse Plan Formulary |
Humana Gold Choice H4774-003 (PFFS)
|
$29.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,232.94 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-005 (PFFS)
|
$29.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
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 |
Humana Gold Choice H4774-001 (PFFS)
|
$30.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:280 /28Days | $4,241.82 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$31.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $4,322.72 |
Browse Plan Formulary |
ArchCare - Institutional Equiv SNP - NYC (
|
$32.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $4,284.42 |
Browse Plan Formulary |
ArchCare - Institutional Equiv SNP - NYC (
|
$32.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $4,284.42 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
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 |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Senior Blue HMO 652 P
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
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 |
Fidelis Dual Advantage Flex Plan (HMO)
|
$33.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,457.44 |
Browse Plan Formulary |
Fidelis Medicare Advantage Flex Plan (HMO-
|
$33.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,457.44 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,434.08 |
Browse Plan Formulary |
Northeast Community Care - Enhanced (HMO)
|
$33.30 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $4,228.16 |
Browse Plan Formulary |
Northeast Community Care - Enhanced (HMO)
|
$33.30 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $4,228.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Northeast Community Care - Enhanced (HMO)
|
$33.30 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $4,228.16 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:8400 /28Days | $4,297.57 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:8400 /28Days | $4,297.57 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:8400 /28Days | $4,297.57 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:8400 /28Days | $4,297.57 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:8400 /28Days | $4,297.57 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Q:8400 /28Days | $4,378.29 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$34.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:8400 /28Days | $4,378.29 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,306.03 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,306.03 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,306.03 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,306.03 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $4,306.03 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,306.03 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,306.03 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,306.03 |
Browse Plan Formulary |
Advantage Platinum NY - Suffolk (HMO)
|
$41.20 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,258.76 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:8400 /28Days | $4,378.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$43.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:8400 /28Days | $4,378.29 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.20 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:8400 /28Days | $4,491.61 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$43.20 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:8400 /28Days | $4,491.61 |
Browse Plan Formulary |
Advantage Health Suffolk - SNP (HMO)
|
$44.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,258.76 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$44.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:8400 /28Days | $4,271.92 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$44.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:8400 /28Days | $4,271.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $4,416.83 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $4,416.83 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $4,416.83 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $4,416.83 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,496.66 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,496.66 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | n/a | None | $4,496.66 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,496.66 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,496.66 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,496.66 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,496.66 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | n/a | None | $4,496.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:8400 /28Days | $4,163.48 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:8400 /28Days | $4,163.48 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$50.60 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:8400 /28Days | $4,163.48 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $4,496.66 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $4,496.66 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $4,496.66 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$65.00 | n/a | None | $4,496.66 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $4,496.66 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $4,496.66 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $4,496.66 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | None | $4,496.66 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$54.30 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:8400 /28Days | $4,378.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
|
$54.30 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:8400 /28Days | $4,378.29 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:8400 /28Days | $4,163.48 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:8400 /28Days | $4,163.48 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$54.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:8400 /28Days | $4,163.48 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
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 |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$69.50 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
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 |
MediBlue Plus (PPO)
|
$70.20 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $4,566.88 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
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 |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 752 (
|
$73.60 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
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 |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
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 |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueShield Forever Blue Medicare PPO 755 (
|
$123.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
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 |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |
BlueCross BlueShield Forever Blue Medicare
|
$157.10 |
$0 |
to be determined |
4 |
Tier 4 |
30% | 25% | P | $4,252.60 |
Browse Plan Formulary |