Daliresp 500ug/1 30 TABLET BOTTLE, PLASTIC (30 TABLET in 1 BOTTLE, PL ) (NDC: 00456009530)
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 |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P | $241.73 |
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 |
Few Generics |
4 |
Non-Preferred Brand |
$95.00 | $275.00 | P | $241.84 |
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 |
3 |
Non-Preferred Brand |
$95.00 | $190.00 | P | $241.93 |
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 |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None | $240.19 |
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 |
4 |
Non-Preferred Brand |
$70.00 | $210.00 | P Q:30 /30Days | $245.82 |
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 |
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 |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | Q:30 /30Days | $241.19 |
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 |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | Q:30 /30Days | $241.19 |
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 |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | Q:30 /30Days | $241.07 |
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 |
$20.00 | $50.00 | Q:30 /30Days | $239.23 |
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 |
$45.00 | $125.00 | Q:30 /30Days | $239.23 |
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 |
$20.00 | $50.00 | Q:30 /30Days | $239.23 |
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 |
CareOne (HMO)
![Email Prescription and/or Health Benefit details for CareOne (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$20.00 | $50.00 | Q:30 /30Days | $239.23 |
Browse Plan Formulary |
Clear Skies (HMO SNP)
![Email Prescription and/or Health Benefit details for Clear Skies (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics |
3 |
Non-Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days | $248.39 |
Browse Plan Formulary |
Coventry Summit Ideal (HMO)
![Email Prescription and/or Health Benefit details for Coventry Summit Ideal (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
2 |
Preferred Brand |
$15.00 | $30.00 | Q:30 /30Days | $244.68 |
Browse Plan Formulary |
Coventry Vista Ideal (HMO)
![Email Prescription and/or Health Benefit details for Coventry Vista Ideal (HMO)](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 |
$35.00 | $70.00 | Q:30 /30Days | $244.68 |
Browse Plan Formulary |
Day Break (HMO)
![Email Prescription and/or Health Benefit details for Day Break (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics |
3 |
Non-Preferred Brand |
$60.00 | $180.00 | Q:30 /30Days | $248.39 |
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 | Q:30 /30Days | $236.02 |
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 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 | Q:30 /30Days | $236.19 |
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 | Q:30 /30Days | $236.24 |
Browse Plan Formulary |
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 |
4 |
Non-Preferred Brand |
33% | n/a | None | $238.71 |
Browse Plan Formulary |
Humana Gold Plus H1036-065C (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-065C (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$20.00 | $50.00 | Q:30 /30Days | $239.23 |
Browse Plan Formulary |
Humana Gold Plus H1036-224 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-224 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Few Generics, Few Brands |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $239.23 |
Browse Plan Formulary |
Humana Gold Plus SNP-CVD/CHF H1036-186 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-CVD/CHF H1036-186 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$20.00 | $50.00 | Q:30 /30Days | $239.23 |
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 |
Humana Gold Plus SNP-DB H1036-121C (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DB H1036-121C (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Some Generics, Few Brands |
3 |
Preferred Brand |
$20.00 | $50.00 | Q:30 /30Days | $239.23 |
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 | Q:30 /30Days | $238.32 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax (HMO)
![Email Prescription and/or Health Benefit details for Medica HealthCare Plans MedicareMax (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$89.00 | n/a | P | $241.84 |
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 | Q:30 /30Days | $235.92 |
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 | Q:30 /30Days | $235.92 |
Browse Plan Formulary |
PHP (HMO SNP)
![Email Prescription and/or Health Benefit details for PHP (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Non-Preferred Brand |
25% | n/a | P | $243.03 |
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 Choice Broward (HMO)
![Email Prescription and/or Health Benefit details for Preferred Choice Broward (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Many Generics |
3 |
Non-Preferred Brand |
$40.00 | $110.00 | P | $241.84 |
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 |
2 |
Preferred Brand |
25% | n/a | None | $236.63 |
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 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$75.00 | n/a | P | $236.83 |
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 |
4 |
Non-Preferred Brand |
$30.00 | n/a | P | $236.83 |
Browse Plan Formulary |
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 |
Many Generics |
4 |
Non-Preferred Brand |
$30.00 | n/a | P | $236.83 |
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 |
4 |
Non-Preferred Brand |
$40.00 | n/a | P | $236.83 |
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 |
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 |
4 |
Non-Preferred Brand |
$0.00 | n/a | None | $238.71 |
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 |
4 |
Non-Preferred Brand |
$0.00 | n/a | None | $238.71 |
Browse Plan Formulary |
Sunrise (HMO)
![Email Prescription and/or Health Benefit details for Sunrise (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics |
3 |
Non-Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days | $248.39 |
Browse Plan Formulary |
Humana Gold Plus SNP-I H1036-185 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-I H1036-185 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$7.70 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $239.23 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-103A (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H1036-103A (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$8.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $239.23 |
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) |
$9.40 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$88.00 | $176.00 | Q:31 /31Days | $246.22 |
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 |
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) |
$10.40 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Brand |
$84.00 | $168.00 | Q:31 /31Days | $246.22 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-162 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H1036-162 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$10.50 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $239.23 |
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 |
4 |
Non-Preferred Brand |
$88.00 | $176.00 | Q:31 /31Days | $245.97 |
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) |
$11.70 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $239.23 |
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) |
$17.00 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:30 /30Days | $239.23 |
Browse Plan Formulary |
Coventry Summit Maximum (HMO SNP)
![Email Prescription and/or Health Benefit details for Coventry Summit Maximum (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.90 |
$0 |
Many Generics |
2 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days | $244.11 |
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 (PPO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.80 |
$310 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | P | $241.83 |
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 |
3 |
Non-Preferred Brand |
25% | n/a | P | $241.67 |
Browse Plan Formulary |
Advantage by Sunshine Health (HMO SNP)
![Email Prescription and/or Health Benefit details for Advantage by Sunshine Health (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$310 |
Many Generics |
2 |
Preferred Brand |
$45.00 | $45.00 | None | $244.52 |
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 |
3 |
Non-Preferred Brand |
25% | 25% | P | $241.67 |
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 |
4 |
Tier 4 |
15% | 15% | P | $241.73 |
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 |
3 |
Non-Preferred Brand |
$95.00 | $285.00 | None | $240.20 |
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 |
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 |
4 |
Non-Preferred Brand |
25% | 25% | None | $240.19 |
Browse Plan Formulary |
Coventry Vista Maximum Choice (HMO SNP)
![Email Prescription and/or Health Benefit details for Coventry Vista Maximum Choice (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$22.10 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days | $244.06 |
Browse Plan Formulary |
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 | Q:30 /30Days | $236.07 |
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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% | Q:30 /30Days | $236.07 |
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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 |
4 |
Non-Preferred Brand |
25% | n/a | None | $237.41 |
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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 | Q:30 /30Days | $236.07 |
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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 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% | Q:30 /30Days | $236.07 |
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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 |
4 |
Non-Preferred Brand |
$25.00 | n/a | P | $236.76 |
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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 |
4 |
Non-Preferred Brand |
$25.00 | n/a | P | $236.76 |
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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 |
4 |
Non-Preferred Brand |
$75.00 | n/a | P | $236.83 |
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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 |
4 |
Non-Preferred Brand |
25% | 25% | None | $240.21 |
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Sunny Days (HMO SNP)
![Email Prescription and/or Health Benefit details for Sunny Days (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.90 |
$0 |
All Generics |
3 |
Non-Preferred Brand |
25% | 25% | Q:30 /30Days | $248.39 |
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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 |
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 |
3 |
Non-Preferred Brand |
$95.00 | $190.00 | P | $241.93 |
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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 | Q:30 /30Days | $238.32 |
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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 | Q:30 /30Days | $238.56 |
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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 | Q:30 /30Days | $238.40 |
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BlueMedicare PPO (PPO)
![Email Prescription and/or Health Benefit details for BlueMedicare PPO (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$127.00 |
$0 |
Many Generics |
4 |
Non-Preferred Brand |
$75.00 | $225.00 | Q:30 /30Days | $241.21 |
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