ZEMPLAR 5MCG/ML VIAL (NDC: 00074165802)
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 Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-091 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 55 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
Windsor Medicare Extra Emerald Plan (HMO)
![Email Prescription and/or Health Benefit details for Windsor Medicare Extra Emerald Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $5,121.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
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 |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
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 |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
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 |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
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 |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
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 |
SecureHorizons MedicareDirect Rx Plan 58 (
![Email Prescription and/or Health Benefit details for SecureHorizons MedicareDirect Rx Plan 58 (](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$12.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
Windsor Medicare Extra Gold Plan (HMO)
![Email Prescription and/or Health Benefit details for Windsor Medicare Extra Gold Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$15.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $5,121.86 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus Plan 2 (HMO-POS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus Plan 2 (HMO-POS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus Plan 2 (HMO-POS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus Plan 2 (HMO-POS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
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 |
AARP MedicareComplete Plus Plan 2 (HMO-POS
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus Plan 2 (HMO-POS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus Plan 2 (HMO-POS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus Plan 2 (HMO-POS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus Plan 2 (HMO-POS](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
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 |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
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 |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
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 |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $110.00 | None | $5,041.72 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,199.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,886.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,886.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,886.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,886.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Four (P](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,886.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,886.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,886.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,886.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $5,102.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
![Email Prescription and/or Health Benefit details for CIGNA Medicare Access Plus RX Plan Two (PF](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $4,772.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-015 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-015 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 3 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.70 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $107.00 | None | $5,041.72 |
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 |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-093 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-090 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Windsor Medicare Extra Diabetes Plan (HMO)
![Email Prescription and/or Health Benefit details for Windsor Medicare Extra Diabetes Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $135.00 | P | $5,121.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Diamond Plan (HMO)
![Email Prescription and/or Health Benefit details for Windsor Medicare Extra Diamond Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | P | $5,121.86 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
![Email Prescription and/or Health Benefit details for Windsor Medicare Extra Fusion Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$28.50 |
$0 |
to be determined |
4 |
Tier 4 |
$45.00 | $135.00 | P | $5,121.86 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
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 |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
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 |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
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 |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
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 |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
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 |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
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 |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
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 |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
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 |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
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 |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
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 |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
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 |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $5,041.72 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
![Email Prescription and/or Health Benefit details for AmeriChoice Secure Plus Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | None | $5,041.72 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4461-011 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H4461-011 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-001 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-001 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H2944-092 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-012 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-012 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.90 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Diamond (PPO)
![Email Prescription and/or Health Benefit details for BlueAdvantage Diamond (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Ruby (PPO)
![Email Prescription and/or Health Benefit details for BlueAdvantage Ruby (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.30 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Platinum (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
![Email Prescription and/or Health Benefit details for BlueAdvantage Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.40 |
$0 |
to be determined |
4 |
Tier 4 |
$55.00 | $137.50 | None | $5,056.73 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H4461-016 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |