LEVOFLOXACIN 250 MG TABLET [LEVAQUIN] (50.000 EA ) (NDC: 65862053650)
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 Choice (PPO)
![Email Prescription and/or Health Benefit details for AARP MedicareComplete Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$3.00 | $0.00 | None | $8.13 |
Browse Plan Formulary |
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 |
$395* |
to be determined |
1* |
Preferred Generic |
$3.00 | $0.00 | None | $9.39 |
Browse Plan Formulary |
Aetna Medicare Choice Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Choice Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$195* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | None | $14.19 |
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) |
$0.00 |
$295* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | None | $14.09 |
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 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | Q:1 /1Days | $11.84 |
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 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $2.51 |
Browse Plan Formulary |
AvMed Medicare Circle (HMO)
![Email Prescription and/or Health Benefit details for AvMed Medicare Circle (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $2.41 |
Browse Plan Formulary |
BlueMedicare Classic (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | $9.00 | None | $5.99 |
Browse Plan Formulary |
BlueMedicare Premier (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $5.86 |
Browse Plan Formulary |
CareFree (HMO)
![Email Prescription and/or Health Benefit details for CareFree (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$0.00 | $0.00 | None | $3.94 |
Browse Plan Formulary |
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 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | None | $3.94 |
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 |
Coventry Medicare Summit Plan (HMO)
![Email Prescription and/or Health Benefit details for Coventry Medicare Summit Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | None | $14.14 |
Browse Plan Formulary |
Devoted Health Broward (HMO)
![Email Prescription and/or Health Benefit details for Devoted Health Broward (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $4.14 |
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 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:14 /14Days | $3.75 |
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 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:14 /14Days | $3.75 |
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 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:14 /14Days | $3.75 |
Browse Plan Formulary |
HealthSun HealthAdvantage Plan (HMO)
![Email Prescription and/or Health Benefit details for HealthSun HealthAdvantage Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $7.26 |
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 - Diabetes (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus - Diabetes (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$3.00 | $0.00 | None | $3.94 |
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 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$0.00 | $0.00 | None | $3.94 |
Browse Plan Formulary |
Humana Gold Plus H1036-237 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-237 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$0.00 | $0.00 | None | $3.94 |
Browse Plan Formulary |
Humana Gold Plus H1036-237 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-237 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$0.00 | $0.00 | None | $3.94 |
Browse Plan Formulary |
HumanaChoice Florida H5216-068 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice Florida H5216-068 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$12.00 | $0.00 | None | $3.94 |
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 |
$395* |
to be determined |
2* |
Generic |
$20.00 | $0.00 | None | $3.94 |
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 (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 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $16.58 |
Browse Plan Formulary |
MMM - ELITE (HMO)
![Email Prescription and/or Health Benefit details for MMM - ELITE (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $2.88 |
Browse Plan Formulary |
MMM - EXTRA (HMO)
![Email Prescription and/or Health Benefit details for MMM - EXTRA (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $2.88 |
Browse Plan Formulary |
Optimum Gold Rewards Plan (HMO)
![Email Prescription and/or Health Benefit details for Optimum Gold Rewards Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:14 /14Days | $3.75 |
Browse Plan Formulary |
Optimum Platinum Plan (HMO)
![Email Prescription and/or Health Benefit details for Optimum Platinum Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | Q:14 /14Days | $3.75 |
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 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Generic |
25% | n/a | None | $4.03 |
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 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $16.58 |
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 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $14.84 |
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 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $14.84 |
Browse Plan Formulary |
Solis Health Plans (HMO)
![Email Prescription and/or Health Benefit details for Solis Health Plans (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $12.22 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete RP ONE (Regional PPO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete RP ONE (Regional PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$415 |
to be determined |
1 |
All Formulary Drugs |
$0.00 | $0.00 | None | $9.39 |
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 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $2.35 |
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 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 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $2.38 |
Browse Plan Formulary |
WellCare Dividend Prime (HMO)
![Email Prescription and/or Health Benefit details for WellCare Dividend Prime (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $2.26 |
Browse Plan Formulary |
WellCare Elite (HMO)
![Email Prescription and/or Health Benefit details for WellCare Elite (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $2.26 |
Browse Plan Formulary |
WellCare Premier (PPO)
![Email Prescription and/or Health Benefit details for WellCare Premier (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $2.26 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for WellCare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$0.00 | $0.00 | None | $2.32 |
Browse Plan Formulary |
CareExtra (HMO)
![Email Prescription and/or Health Benefit details for CareExtra (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$11.90 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
24% | 24% | None | $3.94 |
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 |
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) |
$18.00 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$0.00 | $0.00 | None | $3.94 |
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) |
$18.20 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$0.00 | $0.00 | None | $3.94 |
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) |
$22.20 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$0.00 | $0.00 | None | $3.94 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H1036-255 (HMO SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H1036-255 (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.10 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$0.00 | $0.00 | None | $3.94 |
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 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $2.32 |
Browse Plan Formulary |
WellCare Reserve (HMO SNP)
![Email Prescription and/or Health Benefit details for WellCare Reserve (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $2.26 |
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 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) |
$25.30 |
$415 |
to be determined |
1 |
All Formulary Drugs |
15% | 15% | None | $9.39 |
Browse Plan Formulary |
Coventry Medicare Summit Plan (HMO SNP)
![Email Prescription and/or Health Benefit details for Coventry Medicare Summit Plan (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.50 |
$415* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | None | $1.69 |
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) |
$26.60 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $2.32 |
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) |
$26.80 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $2.36 |
Browse Plan Formulary |
Preferred Medicare Assist (HMO SNP)
![Email Prescription and/or Health Benefit details for Preferred Medicare Assist (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.00 |
$415* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $9.64 |
Browse Plan Formulary |
UnitedHealthcare Assisted Living Plan (PPO SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Assisted Living Plan (PPO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.70 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $0.00 | None | $8.85 |
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 |
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) |
$30.20 |
$415* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $3.22 |
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) |
$30.30 |
$415* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$0.00 | $0.00 | Q:1 /1Days | $2.54 |
Browse Plan Formulary |
BlueMedicare Complete (HMO SNP)
![Email Prescription and/or Health Benefit details for BlueMedicare Complete (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$415* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $5.72 |
Browse Plan Formulary |
Devoted Health Prime Broward (HMO)
![Email Prescription and/or Health Benefit details for Devoted Health Prime Broward (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$415* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $4.14 |
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) |
$30.30 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:14 /14Days | $3.75 |
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) |
$30.30 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:14 /14Days | $3.75 |
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 |
HealthSun MediMax (HMO)
![Email Prescription and/or Health Benefit details for HealthSun MediMax (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
25% | 25% | None | $7.12 |
Browse Plan Formulary |
Medica HealthCare Plans MedicareMax Plus (HMO SNP)
![Email Prescription and/or Health Benefit details for Medica HealthCare Plans MedicareMax Plus (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$415* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $9.64 |
Browse Plan Formulary |
MMM - PLATINUM (HMO SNP)
![Email Prescription and/or Health Benefit details for MMM - PLATINUM (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$415* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $11.86 |
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) |
$30.30 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:14 /14Days | $3.75 |
Browse Plan Formulary |
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) |
$30.30 |
$415* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:14 /14Days | $3.75 |
Browse Plan Formulary |
Simply Advantage (HMO SNP)
![Email Prescription and/or Health Benefit details for Simply Advantage (HMO SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$415* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $14.84 |
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 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) |
$30.30 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$5.00 | n/a | None | $14.84 |
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) |
$30.30 |
$415* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | n/a | None | $14.84 |
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) |
$30.30 |
$415* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $14.84 |
Browse Plan Formulary |
Simply Select (HMO)
![Email Prescription and/or Health Benefit details for Simply Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.30 |
$415* |
Yes, but No Gap Coverage for this drug. |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $14.84 |
Browse Plan Formulary |
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) |
$30.30 |
$415 |
No additional gap coverage, only the Donut Hole Discount |
1 |
All Formulary Drugs |
25% | 25% | None | $8.34 |
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) |
$31.30 |
$100* |
to be determined |
2* |
Generic |
$15.00 | $0.00 | None | $3.94 |
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 Choice (Regional PPO)
![Email Prescription and/or Health Benefit details for BlueMedicare Choice (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.00 |
$250* |
to be determined |
1* |
Preferred Generic |
$0.00 | $0.00 | None | $6.10 |
Browse Plan Formulary |
HumanaChoice H5216-065 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-065 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.00 |
$350* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$15.00 | $0.00 | None | $3.94 |
Browse Plan Formulary |
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) |
$117.00 |
$200* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$17.00 | $0.00 | None | $3.94 |
Browse Plan Formulary |
BlueMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for BlueMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$147.80 |
$305 |
Yes, but No Gap Coverage for this drug. |
1 |
Preferred Generic |
$3.00 | $9.00 | None | $6.01 |
Browse Plan Formulary |