SEROQUEL 300MG TABLET (60 BOT) (NDC: 00310027460)
2012 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional 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 Choice Plan 2 (Regional PPO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Choice Plan 2 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$95.00 | $275.00 | None | $978.92 |
Browse Plan Formulary |
AARP MedicareComplete Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$30.00 | $80.00 | None | $977.37 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$30.00 | $80.00 | None | $977.37 |
Browse Plan Formulary |
Aetna Medicare Value Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$95.00 | $190.00 | Q:2 /1Days | $977.39 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
![Email Prescription and/or Health Benefit details for Any, Any, Any Gold (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $120.00 | Q:180 /90Days | $981.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AvMed Medicare Choice (HMO)
![Email Prescription and/or Health Benefit details for AvMed Medicare Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | Q:60 /30Days | $981.16 |
Browse Plan Formulary |
BlueMedicare Regional PPO (Regional PPO)
![Email Prescription and/or Health Benefit details for BlueMedicare Regional PPO (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | Q:60 /30Days | $969.09 |
Browse Plan Formulary |
CareFree PLUS (HMO)
![Email Prescription and/or Health Benefit details for CareFree PLUS (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$24.00 | $62.00 | Q:90 /30Days | $974.14 |
Browse Plan Formulary |
CareOne PLUS (HMO)
![Email Prescription and/or Health Benefit details for CareOne PLUS (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$0.00 | $0.00 | Q:90 /30Days | $974.14 |
Browse Plan Formulary |
Freedom Medicare Plan Rx (HMO)
![Email Prescription and/or Health Benefit details for Freedom Medicare Plan Rx (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $985.67 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
![Email Prescription and/or Health Benefit details for Freedom VIP Care (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $986.25 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Freedom VIP Care COPD (HMO SNP)
![Email Prescription and/or Health Benefit details for Freedom VIP Care COPD (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $986.25 |
Browse Plan Formulary |
Freedom VIP Savings (HMO SNP)
![Email Prescription and/or Health Benefit details for Freedom VIP Savings (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $986.25 |
Browse Plan Formulary |
Freedom VIP Savings COPD (HMO SNP)
![Email Prescription and/or Health Benefit details for Freedom VIP Savings COPD (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $986.25 |
Browse Plan Formulary |
Healthy Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Healthy Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:90 /30Days | $1,076.31 |
Browse Plan Formulary |
Healthy Advantage Refund (HMO)
![Email Prescription and/or Health Benefit details for Healthy Advantage Refund (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | Q:90 /30Days | $1,076.31 |
Browse Plan Formulary |
Humana Gold Plus H1036-054C (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-054C (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$0.00 | $0.00 | Q:90 /30Days | $974.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H1036-164 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-164 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$24.00 | $62.00 | Q:90 /30Days | $974.14 |
Browse Plan Formulary |
Humana Reader's Digest Healthy Living Plan (Regional PPO)
![Email Prescription and/or Health Benefit details for Humana Reader's Digest Healthy Living Plan (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$41.00 | $113.00 | Q:90 /30Days | $975.07 |
Browse Plan Formulary |
JacksonHealth for Life (HMO)
![Email Prescription and/or Health Benefit details for JacksonHealth for Life (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:180 /90Days | $988.82 |
Browse Plan Formulary |
JacksonHealth Secure (HMO SNP)
![Email Prescription and/or Health Benefit details for JacksonHealth Secure (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:180 /90Days | $988.82 |
Browse Plan Formulary |
Leon Medical Centers Health Plans - Leon Cares (HMO)
![Email Prescription and/or Health Benefit details for Leon Medical Centers Health Plans - Leon Cares (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | n/a | None | $984.73 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (PSO)
![Email Prescription and/or Health Benefit details for Medica HealthCare Plans MedicareMax (PSO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | n/a | Q:60 /30Days | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica HealthCare Plans MedicareMax Chronic Care (PSO SNP)
![Email Prescription and/or Health Benefit details for Medica HealthCare Plans MedicareMax Chronic Care (PSO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | n/a | Q:60 /30Days | n/a |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Value RX (PSO)
![Email Prescription and/or Health Benefit details for Medica HealthCare Plans MedicareMax Value RX (PSO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$25.00 | n/a | Q:60 /30Days | n/a |
Browse Plan Formulary |
Medicare Masterpiece (HMO)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $75.00 | Q:180 /90Days | $980.40 |
Browse Plan Formulary |
Medicare Masterpiece Premier - COPD (HMO SNP)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier - COPD (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | Q:180 /90Days | $982.20 |
Browse Plan Formulary |
Medicare Masterpiece Premier - Dementia (HMO SNP)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier - Dementia (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | Q:180 /90Days | $982.23 |
Browse Plan Formulary |
Medicare Masterpiece Premier - Diabetes, CHF, CVD (HMO SNP)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Premier - Diabetes, CHF, CVD (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$20.00 | $50.00 | Q:180 /90Days | $982.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Optimum Gold Rewards Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Optimum Gold Rewards Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | None | $985.64 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Optimum Platinum Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $985.64 |
Browse Plan Formulary |
Positive Healthcare Partners (HMO SNP)
![Email Prescription and/or Health Benefit details for Positive Healthcare Partners (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$320 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | n/a |
Browse Plan Formulary |
Preferred Choice Dade (HMO-POS)
![Email Prescription and/or Health Benefit details for Preferred Choice Dade (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:60 /30Days | $990.65 |
Browse Plan Formulary |
Preferred Complete Care (HMO)
![Email Prescription and/or Health Benefit details for Preferred Complete Care (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:60 /30Days | $990.65 |
Browse Plan Formulary |
Preferred Gold Option (HMO)
![Email Prescription and/or Health Benefit details for Preferred Gold Option (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$15.00 | $30.00 | Q:60 /30Days | $992.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Preferred Medicare Assist (HMO-POS SNP)
![Email Prescription and/or Health Benefit details for Preferred Medicare Assist (HMO-POS SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:60 /30Days | $991.64 |
Browse Plan Formulary |
Preferred Premium Advantage Miami-Dade (HMO-POS)
![Email Prescription and/or Health Benefit details for Preferred Premium Advantage Miami-Dade (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | Q:60 /30Days | $990.65 |
Browse Plan Formulary |
Preferred Special Care Miami-Dade (HMO SNP)
![Email Prescription and/or Health Benefit details for Preferred Special Care Miami-Dade (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | Q:60 /30Days | $990.65 |
Browse Plan Formulary |
PUP EASY (HMO)
![Email Prescription and/or Health Benefit details for PUP EASY (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$30.00 | $80.00 | None | $977.37 |
Browse Plan Formulary |
PUP REWARDS (HMO)
![Email Prescription and/or Health Benefit details for PUP REWARDS (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $978.01 |
Browse Plan Formulary |
Simply Extra (HMO)
![Email Prescription and/or Health Benefit details for Simply Extra (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | Q:60 /30Days | $1,013.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simply More (HMO)
![Email Prescription and/or Health Benefit details for Simply More (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$0.00 | $0.00 | Q:60 /30Days | $1,013.24 |
Browse Plan Formulary |
Simply Options (HMO-POS)
![Email Prescription and/or Health Benefit details for Simply Options (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$15.00 | $45.00 | Q:60 /30Days | $1,013.24 |
Browse Plan Formulary |
WellCare Choice (HMO)
![Email Prescription and/or Health Benefit details for WellCare Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $75.00 | Q:93 /31Days | $987.69 |
Browse Plan Formulary |
WellCare Dividend (HMO)
![Email Prescription and/or Health Benefit details for WellCare Dividend (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$49.00 | $122.50 | Q:93 /31Days | $987.69 |
Browse Plan Formulary |
WellCare Select (HMO-POS SNP)
![Email Prescription and/or Health Benefit details for WellCare Select (HMO-POS SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.10 |
$320 |
to be determined |
3 |
Tier 3 |
$95.00 | $237.50 | Q:93 /31Days | $992.55 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Plus (PSO SNP)
![Email Prescription and/or Health Benefit details for Medica HealthCare Plans MedicareMax Plus (PSO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.40 |
$320 |
to be determined |
2 |
Tier 2 |
35% | n/a | Q:60 /30Days | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H1036-163 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H1036-163 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.60 |
$320 |
to be determined |
3 |
Tier 3 |
$45.00 | $125.00 | Q:90 /30Days | $974.14 |
Browse Plan Formulary |
CareNeeds (HMO SNP)
![Email Prescription and/or Health Benefit details for CareNeeds (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.80 |
$320 |
to be determined |
3 |
Tier 3 |
$43.00 | $119.00 | Q:90 /30Days | $974.14 |
Browse Plan Formulary |
CareNeeds PLUS (HMO SNP)
![Email Prescription and/or Health Benefit details for CareNeeds PLUS (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.80 |
$320 |
to be determined |
3 |
Tier 3 |
$44.00 | $122.00 | Q:90 /30Days | $974.14 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-077A (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H1036-077A (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.80 |
$320 |
to be determined |
3 |
Tier 3 |
$45.00 | $125.00 | Q:90 /30Days | $974.14 |
Browse Plan Formulary |
Simply Care (HMO SNP)
![Email Prescription and/or Health Benefit details for Simply Care (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.80 |
$0 |
to be determined |
3 |
Tier 3 |
$10.00 | n/a | Q:60 /30Days | $1,013.24 |
Browse Plan Formulary |
Simply Comfort (HMO SNP)
![Email Prescription and/or Health Benefit details for Simply Comfort (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.80 |
$0 |
to be determined |
3 |
Tier 3 |
$10.00 | n/a | Q:60 /30Days | $1,013.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simply Complete (HMO SNP)
![Email Prescription and/or Health Benefit details for Simply Complete (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.80 |
$0 |
to be determined |
3 |
Tier 3 |
$10.00 | $30.00 | Q:60 /30Days | $1,013.24 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
![Email Prescription and/or Health Benefit details for WellCare Access (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.80 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $75.00 | Q:93 /31Days | $987.69 |
Browse Plan Formulary |
Medicare Masterpiece Plus (HMO-POS)
![Email Prescription and/or Health Benefit details for Medicare Masterpiece Plus (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $110.00 | Q:180 /90Days | $982.26 |
Browse Plan Formulary |
HumanaChoice R5826-005 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-005 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.80 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $110.00 | Q:90 /30Days | $975.07 |
Browse Plan Formulary |
HumanaChoice H5415-056 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5415-056 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
to be determined |
2 |
Tier 2 |
$43.00 | $119.00 | Q:90 /30Days | $974.77 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$68.00 |
$0 |
to be determined |
4 |
Tier 4 |
$95.00 | $190.00 | Q:2 /1Days | $980.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H8145-061 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-061 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | Q:90 /30Days | $975.48 |
Browse Plan Formulary |