PILOCARPINE 1% EYE DROPS (15 ML ) (NDC: 61314020315)
2014 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 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$8.00 | $16.00 | None | $67.90 |
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 |
Few Generics |
2 |
Preferred Brand |
$45.00 | $90.00 | None | $71.89 |
Browse Plan Formulary |
Amerivantage Classic+ Rx Plan (HMO)
![Email Prescription and/or Health Benefit details for Amerivantage Classic+ Rx Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None | $70.82 |
Browse Plan Formulary |
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 |
Many Generics |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $40.01 |
Browse Plan Formulary |
AvMed Medicare Choice Elect (HMO)
![Email Prescription and/or Health Benefit details for AvMed Medicare Choice Elect (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$4.00 | $0.00 | None | $40.01 |
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 |
BlueMedicare HMO LifeTime (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare HMO LifeTime (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $24.46 |
Browse Plan Formulary |
BlueMedicare HMO PrimeTime (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare HMO PrimeTime (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $24.46 |
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 |
$30 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Non-Preferred Generic |
$33.00 | $99.00 | None | $28.85 |
Browse Plan Formulary |
CareDirect (HMO SNP)
![Email Prescription and/or Health Benefit details for CareDirect (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$5.00 | $5.00 | None | $94.67 |
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 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$35.00 | $95.00 | None | $94.67 |
Browse Plan Formulary |
CareHeart (HMO SNP)
![Email Prescription and/or Health Benefit details for CareHeart (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$5.00 | $5.00 | None | $94.67 |
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 |
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 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$5.00 | $5.00 | None | $94.67 |
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 |
Many Generics |
2 |
Preferred Brand |
$30.00 | $60.00 | None | $77.90 |
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 |
Many Generics |
2 |
Preferred Brand |
$20.00 | $40.00 | None | $77.01 |
Browse Plan Formulary |
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 |
Many Generics |
2 |
Preferred Brand |
$20.00 | $40.00 | None | $77.01 |
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 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$30.00 | $60.00 | None | $77.01 |
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 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$30.00 | $60.00 | None | $77.01 |
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 |
Healthy Advantage Plan (HMO)
![Email Prescription and/or Health Benefit details for Healthy Advantage Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$0.00 | n/a | None | $71.83 |
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 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$5.00 | $5.00 | None | $94.67 |
Browse Plan Formulary |
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 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$35.00 | $95.00 | None | $94.67 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF H1036-189 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-CVD/CHF H1036-189 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$5.00 | $5.00 | None | $94.67 |
Browse Plan Formulary |
Humana Gold Plus SNP-DB H1036-188 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DB H1036-188 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$5.00 | $5.00 | None | $94.67 |
Browse Plan Formulary |
HumanaChoice R5826-074 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-074 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
Few Generics, Few Brands |
3* |
Preferred Brand |
$45.00 | $125.00 | None | $93.87 |
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 |
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 |
Many Generics |
1 |
Generic |
$0.00 | n/a | None | $57.94 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (HMO-POS)
![Email Prescription and/or Health Benefit details for Medica HealthCare Plans MedicareMax (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | n/a | None | $67.33 |
Browse Plan Formulary |
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 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$30.00 | $60.00 | None | $77.82 |
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 |
Many Generics |
2 |
Preferred Brand |
$5.00 | $10.00 | None | $77.82 |
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 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $67.33 |
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 |
Many Generics, Some Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $67.33 |
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 Medical Plan Choice (HMO)
![Email Prescription and/or Health Benefit details for Preferred Medical Plan Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics, Many Brands |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $81.34 |
Browse Plan Formulary |
Preferred Medical Plan Value (HMO)
![Email Prescription and/or Health Benefit details for Preferred Medical Plan Value (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $81.34 |
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 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $67.33 |
Browse Plan Formulary |
Simply Clear (HMO SNP)
![Email Prescription and/or Health Benefit details for Simply Clear (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
25% | n/a | None | $78.81 |
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 |
Many Generics |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $78.80 |
Browse Plan Formulary |
Simply Level (HMO SNP)
![Email Prescription and/or Health Benefit details for Simply Level (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics, Few Brands |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $78.80 |
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 |
All Generics, All Brands |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $78.80 |
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 |
Many Generics |
2 |
Non-Preferred Generic |
$0.00 | $0.00 | None | $78.80 |
Browse Plan Formulary |
SunPlus Advantage Plan (HMO)
![Email Prescription and/or Health Benefit details for SunPlus Advantage Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics, All Brands |
2 |
Non-Preferred Generic |
$0.00 | n/a | None | $71.83 |
Browse Plan Formulary |
SunPlus Diabetes Special Needs Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for SunPlus Diabetes Special Needs Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics, All Brands |
2 |
Non-Preferred Generic |
$0.00 | n/a | None | $71.83 |
Browse Plan Formulary |
Humana Gold Plus SNP-I H1036-187 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-I H1036-187 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$7.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $94.67 |
Browse Plan Formulary |
WellCare Select (HMO SNP)
![Email Prescription and/or Health Benefit details for WellCare Select (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.60 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $70.00 | None | $53.40 |
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 H1036-077A (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) |
$11.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $94.67 |
Browse Plan Formulary |
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) |
$12.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $94.67 |
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) |
$12.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $70.00 | None | $52.13 |
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) |
$13.60 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $94.67 |
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) |
$17.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $94.67 |
Browse Plan Formulary |
WellCare Liberty (HMO SNP)
![Email Prescription and/or Health Benefit details for WellCare Liberty (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$35.00 | $70.00 | None | $52.13 |
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 |
UnitedHealthcare Nursing Home Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.90 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $67.18 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Plus (HMO-POS SNP)
![Email Prescription and/or Health Benefit details for Medica HealthCare Plans MedicareMax Plus (HMO-POS SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.60 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | n/a | None | $67.32 |
Browse Plan Formulary |
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) |
$21.20 |
$0 |
Many Generics |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $67.32 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete RP (Regional PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $67.90 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Options Plus (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.00 |
$310* |
Many Generics, Few Brands |
1* |
Generic |
$0.00 | $0.00 | None | $70.82 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO SNP)
![Email Prescription and/or Health Benefit details for Amerivantage Specialty + Rx (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$310 |
Some Generics |
2 |
Non-Preferred Generic |
25% | 25% | None | $70.82 |
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 Medi-Medi Full (HMO SNP)
![Email Prescription and/or Health Benefit details for Freedom Medi-Medi Full (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
n/a | n/a | None | $77.55 |
Browse Plan Formulary |
Freedom Medi-Medi Partial (HMO SNP)
![Email Prescription and/or Health Benefit details for Freedom Medi-Medi Partial (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $77.55 |
Browse Plan Formulary |
MediMax (HMO)
![Email Prescription and/or Health Benefit details for MediMax (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$310 |
Call plan for details |
2 |
Non-Preferred Generic |
25% | n/a | None | $72.00 |
Browse Plan Formulary |
Optimum Emerald Full (HMO SNP)
![Email Prescription and/or Health Benefit details for Optimum Emerald Full (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
n/a | n/a | None | $77.44 |
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Optimum Emerald Partial (HMO SNP)
![Email Prescription and/or Health Benefit details for Optimum Emerald Partial (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $77.44 |
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) |
$22.10 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$0.00 | n/a | None | $78.80 |
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 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) |
$22.10 |
$0 |
Many Generics |
2 |
Non-Preferred Generic |
$0.00 | n/a | None | $78.80 |
Browse Plan Formulary |
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) |
$22.10 |
$310* |
Many Generics |
2* |
Non-Preferred Generic |
$0.00 | $0.00 | None | $78.80 |
Browse Plan Formulary |
Touch Institutional Special Needs Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Touch Institutional Special Needs Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$310 |
Some Generics |
2 |
Non-Preferred Generic |
25% | 25% | None | $70.82 |
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) |
$35.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $90.00 | None | $71.85 |
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) |
$36.60 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$40.00 | $110.00 | None | $93.87 |
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) |
$45.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $94.08 |
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) |
$103.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | None | $93.86 |
Browse Plan Formulary |