SEREVENT DIS AER 50MCG (60 BLPK) (NDC: 00173052100)
2019 Medicare Prescription Drug Plan (MAPD) Information
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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 Plan 6 (HMO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Plan 6 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $410.97 |
Browse Plan Formulary |
Aetna Better Health of Ohio, MyCare Ohio (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Aetna Better Health of Ohio, MyCare Ohio (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Brand Drugs |
0% | 0% | Q:60 /30Days | $393.62 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:60 /30Days | $396.05 |
Browse Plan Formulary |
Aetna Medicare Value Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$145 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:60 /30Days | $396.13 |
Browse Plan Formulary |
Allwell Medicare (HMO)
![Email Prescription and/or Health Benefit details for Allwell Medicare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$37.00 | $111.00 | Q:2 /1Days | $393.73 |
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 |
Anthem MediBlue Essential (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$60 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $84.00 | Q:60 /30Days | $384.05 |
Browse Plan Formulary |
Anthem MediBlue Preferred (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $84.00 | Q:60 /30Days | $383.88 |
Browse Plan Formulary |
Bright Advantage (HMO)
![Email Prescription and/or Health Benefit details for Bright Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:60 /30Days | $386.75 |
Browse Plan Formulary |
Bright Advantage Flex (PPO)
![Email Prescription and/or Health Benefit details for Bright Advantage Flex (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:60 /30Days | $386.75 |
Browse Plan Formulary |
CareSource Advantage Zero Premium (HMO)
![Email Prescription and/or Health Benefit details for CareSource Advantage Zero Premium (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:60 /30Days | $383.29 |
Browse Plan Formulary |
Humana Gold Plus - Diabetes and Heart (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus - Diabetes and Heart (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $407.20 |
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 |
Humana Gold Plus H6622-021 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-021 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $407.29 |
Browse Plan Formulary |
Humana Gold Plus H6622-021 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-021 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $407.44 |
Browse Plan Formulary |
HumanaChoice H5525-042 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5525-042 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $406.92 |
Browse Plan Formulary |
MediGold Southwest OH Essential Care (HMO)
![Email Prescription and/or Health Benefit details for MediGold Southwest OH Essential Care (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:60 /30Days | $381.87 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$160 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | Q:60 /30Days | $378.97 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$160 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | Q:60 /30Days | $383.59 |
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 |
MeridianCare Enhanced (HMO)
![Email Prescription and/or Health Benefit details for MeridianCare Enhanced (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $389.56 |
Browse Plan Formulary |
MeridianCare Essential (HMO)
![Email Prescription and/or Health Benefit details for MeridianCare Essential (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:60 /30Days | $389.56 |
Browse Plan Formulary |
MeridianCare Essential Smile (HMO)
![Email Prescription and/or Health Benefit details for MeridianCare Essential Smile (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:60 /30Days | $389.56 |
Browse Plan Formulary |
Molina Dual Options ? MyCareOhio (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Molina Dual Options ? MyCareOhio (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Brand Drugs |
0% | 0% | Q:60 /30Days | $383.31 |
Browse Plan Formulary |
Mutual of Omaha CareAdvantage Complete (HMO)
![Email Prescription and/or Health Benefit details for Mutual of Omaha CareAdvantage Complete (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $115.00 | Q:60 /30Days | $382.90 |
Browse Plan Formulary |
Humana Gold Plus H6622-055 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-055 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$15.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $407.36 |
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 |
HumanaChoice H5216-109 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-109 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $407.40 |
Browse Plan Formulary |
Aetna Medicare OH Connect Gold 2 (Regional PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare OH Connect Gold 2 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.50 |
$350 |
to be determined |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:60 /30Days | $396.17 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.60 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
3 |
All Formulary Drugs |
15% | 15% | Q:60 /30Days | $410.77 |
Browse Plan Formulary |
HumanaChoice R5495-002 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5495-002 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.40 |
$395 |
to be determined |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $406.93 |
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) |
$28.00 |
$170* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$45.00 | $125.00 | Q:60 /30Days | $411.79 |
Browse Plan Formulary |
Mutual of Omaha CareAdvantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Mutual of Omaha CareAdvantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $115.00 | Q:60 /30Days | $383.05 |
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 H6622-015 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H6622-015 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.20 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $406.46 |
Browse Plan Formulary |
Allwell Dual Medicare (HMO SNP)
![Email Prescription and/or Health Benefit details for Allwell Dual Medicare (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$50 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:2 /1Days | $383.31 |
Browse Plan Formulary |
Anthem MediBlue Dual Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Dual Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$415 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $383.88 |
Browse Plan Formulary |
Anthem MediBlue Extra (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Extra (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$415 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:60 /30Days | $383.88 |
Browse Plan Formulary |
CareSource Advantage (HMO)
![Email Prescription and/or Health Benefit details for CareSource Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:60 /30Days | $383.29 |
Browse Plan Formulary |
MeridianCare Extra (HMO SNP)
![Email Prescription and/or Health Benefit details for MeridianCare Extra (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 25% | Q:60 /30Days | $389.56 |
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 |
MeridianCare Extra Smile (HMO SNP)
![Email Prescription and/or Health Benefit details for MeridianCare Extra Smile (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 25% | Q:60 /30Days | $389.56 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 1 (PPO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan 1 (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
3 |
All Formulary Drugs |
25% | 25% | Q:60 /30Days | $410.70 |
Browse Plan Formulary |
UnitedHealthcare Nursing Home Plan 2 (PPO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Nursing Home Plan 2 (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
3 |
All Formulary Drugs |
25% | 25% | Q:60 /30Days | $410.88 |
Browse Plan Formulary |
Bright Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for Bright Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:60 /30Days | $386.75 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | Q:60 /30Days | $378.97 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | Q:60 /30Days | $383.59 |
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 |
MedMutual Advantage Select (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.00 |
$160 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | Q:60 /30Days | $378.97 |
Browse Plan Formulary |
MedMutual Advantage Select (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.00 |
$160 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | Q:60 /30Days | $383.59 |
Browse Plan Formulary |
Aetna Medicare OH Connect Gold (Regional PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare OH Connect Gold (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$53.30 |
$0 |
to be determined |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:60 /30Days | $396.17 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Access (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$56.00 |
$50 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $84.00 | Q:60 /30Days | $384.06 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Access (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$56.00 |
$50 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $84.00 | Q:60 /30Days | $382.78 |
Browse Plan Formulary |
Bright Advantage Flex Plus (PPO)
![Email Prescription and/or Health Benefit details for Bright Advantage Flex Plus (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$56.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$42.00 | $126.00 | Q:60 /30Days | $386.75 |
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 |
HumanaChoice H5216-023 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-023 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.00 |
$175 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $407.55 |
Browse Plan Formulary |
MediGold Flexible Choice (PPO)
![Email Prescription and/or Health Benefit details for MediGold Flexible Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $94.00 | Q:60 /30Days | $381.87 |
Browse Plan Formulary |
Anthem MediBlue Access Basic (Regional PPO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Access Basic (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.80 |
$200 |
to be determined |
3 |
Preferred Brand |
$42.00 | $84.00 | Q:60 /30Days | $383.88 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$63.00 |
$60 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $84.00 | Q:60 /30Days | $385.51 |
Browse Plan Formulary |
CareSource Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for CareSource Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$67.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $117.50 | Q:60 /30Days | $383.29 |
Browse Plan Formulary |
MedMutual Advantage Preferred (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$74.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | Q:60 /30Days | $378.97 |
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 |
MedMutual Advantage Preferred (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$74.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | Q:60 /30Days | $383.59 |
Browse Plan Formulary |
Humana Gold Plus H6622-019 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-019 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$87.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $406.84 |
Browse Plan Formulary |
Aetna Medicare Choice Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Choice Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$98.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:60 /30Days | $396.08 |
Browse Plan Formulary |
MedMutual Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | Q:60 /30Days | $378.97 |
Browse Plan Formulary |
MedMutual Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$99.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | Q:60 /30Days | $383.59 |
Browse Plan Formulary |
Humana Gold Choice H8145-032 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-032 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$103.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $407.24 |
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 |
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) |
$111.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $125.00 | Q:60 /30Days | $410.97 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Premium (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$119.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | Q:60 /30Days | $378.97 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Premium (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$119.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | Q:60 /30Days | $383.59 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Standard Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:60 /30Days | $396.08 |
Browse Plan Formulary |
MediGold Southwest OH Classic Preferred (HMO)
![Email Prescription and/or Health Benefit details for MediGold Southwest OH Classic Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:60 /30Days | $381.87 |
Browse Plan Formulary |
HumanaChoice H5525-030 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5525-030 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$155.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days | $406.93 |
Browse Plan Formulary |