GLATIRAMER 40 MG/ML SYRINGE [Copaxone] (1 ML ) (NDC: 00378696112)
2020 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 |
Aetna Better Health Premier Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Aetna Better Health Premier Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P Q:12 /28Days | $4,719.84 |
Browse Plan Formulary |
Align Connect (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Align Connect (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | None | $1,872.48 |
Browse Plan Formulary |
AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
1 |
Tier 1 |
0% | 0% | P | $1,922.88 |
Browse Plan Formulary |
BCN Advantage HMO HealthyValue (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO HealthyValue (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No |
5 |
Tier 5 |
28% | n/a | None | $3,138.36 |
Browse Plan Formulary |
BCN Advantage HMO HealthyValue (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO HealthyValue (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No |
5 |
Tier 5 |
28% | n/a | None | $4,621.56 |
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 |
BCN Advantage HMO HealthyValue (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO HealthyValue (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No |
5 |
Tier 5 |
28% | n/a | None | $3,925.68 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Basic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | None | $4,139.76 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Basic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | None | $4,672.08 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Basic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | None | $4,440.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Basic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | None | $4,052.64 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Basic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | None | $4,150.44 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HAP Empowered MI Health Link (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for HAP Empowered MI Health Link (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
1 |
Tier 1 |
0% | 0% | P | $4,359.96 |
Browse Plan Formulary |
HAP Primary Choice Medicare (HMO)
![Email Prescription and/or Health Benefit details for HAP Primary Choice Medicare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $4,614.84 |
Browse Plan Formulary |
HAP Senior Plus (HMO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $3,147.12 |
Browse Plan Formulary |
HAP Senior Plus Option 1 (PPO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 1 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $3,147.12 |
Browse Plan Formulary |
Humana Gold Plus H8908-004 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H8908-004 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:12 /28Days | $2,688.12 |
Browse Plan Formulary |
Molina Dual Options (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Molina Dual Options (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P Q:12 /28Days | $4,620.48 |
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 |
Principle (HMO)
![Email Prescription and/or Health Benefit details for Principle (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$125 |
No |
5 |
Tier 5 |
30% | n/a | P Q:12 /28Days | $4,089.48 |
Browse Plan Formulary |
PriorityMedicare Edge (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Edge (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | None | $3,954.00 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Key (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | None | $3,954.00 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Key (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | None | $3,870.24 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Key (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | None | $3,844.32 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Key (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | None | $4,676.52 |
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 |
PriorityMedicare Key (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Key (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | None | $3,339.60 |
Browse Plan Formulary |
WellCare Essential (HMO-POS)
![Email Prescription and/or Health Benefit details for WellCare Essential (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:12 /28Days | n/a |
Browse Plan Formulary |
WellCare Explore (HMO-POS)
![Email Prescription and/or Health Benefit details for WellCare Explore (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:12 /28Days | n/a |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$9.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | None | $4,150.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$9.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | None | $4,164.96 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$9.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | None | $4,672.08 |
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 |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$9.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | None | $4,351.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Essential (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$9.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | None | $4,052.64 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Ideal (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.00 |
$125 |
No |
5 |
Tier 5 |
30% | n/a | None | $3,844.32 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Ideal (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.00 |
$125 |
No |
5 |
Tier 5 |
30% | n/a | None | $4,676.52 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Ideal (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.00 |
$125 |
No |
5 |
Tier 5 |
30% | n/a | None | $3,339.60 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Ideal (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.00 |
$125 |
No |
5 |
Tier 5 |
30% | n/a | None | $3,954.00 |
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 |
PriorityMedicare Ideal (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Ideal (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.00 |
$125 |
No |
5 |
Tier 5 |
30% | n/a | None | $3,870.24 |
Browse Plan Formulary |
WellCare Elite Smile (HMO-POS)
![Email Prescription and/or Health Benefit details for WellCare Elite Smile (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.10 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:12 /28Days | n/a |
Browse Plan Formulary |
WellCare Extra Plus (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for WellCare Extra Plus (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.60 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:12 /28Days | $4,715.64 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H8908-005 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H8908-005 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.20 |
$425 |
No |
5 |
Tier 5 |
25% | n/a | P Q:12 /28Days | $2,688.12 |
Browse Plan Formulary |
WellCare Plus (HMO)
![Email Prescription and/or Health Benefit details for WellCare Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.60 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:12 /28Days | $4,715.88 |
Browse Plan Formulary |
HumanaChoice H5216-133 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-133 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.00 |
$270 |
No |
5 |
Tier 5 |
28% | n/a | P Q:12 /28Days | $2,688.12 |
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 |
BCN Advantage HMO HealthySaver (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO HealthySaver (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | None | $4,621.56 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO HealthySaver (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | None | $3,925.68 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO HealthySaver (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | None | $3,138.36 |
Browse Plan Formulary |
HumanaChoice R3887-002 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R3887-002 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.00 |
$210 |
No |
5 |
Tier 5 |
29% | n/a | P Q:12 /28Days | $2,688.12 |
Browse Plan Formulary |
WellCare Extra Smile (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for WellCare Extra Smile (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.30 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:12 /28Days | $4,715.64 |
Browse Plan Formulary |
Align Thrive (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Align Thrive (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.20 |
$435 |
No |
1 |
Tier 1 |
25% | n/a | None | $1,872.48 |
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 Complete Care (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Complete Care (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.20 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:12 /28Days | $4,345.92 |
Browse Plan Formulary |
PriorityMedicare D-SNP (HMO D-SNP)
![Email Prescription and/or Health Benefit details for PriorityMedicare D-SNP (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.20 |
$435 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | None | $3,969.72 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO D-SNP)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Dual Complete (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.20 |
$435 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | Q:12 /28Days | $4,389.60 |
Browse Plan Formulary |
Cardinal (HMO)
![Email Prescription and/or Health Benefit details for Cardinal (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$0 |
No |
5 |
Tier 5 |
30% | n/a | P Q:12 /28Days | $4,089.48 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | None | $3,870.24 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | None | $3,844.32 |
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 |
PriorityMedicare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | None | $4,676.52 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | None | $3,339.60 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare Value (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$42.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | None | $3,954.00 |
Browse Plan Formulary |
Humana Gold Plus H8908-001 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H8908-001 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:12 /28Days | $2,688.12 |
Browse Plan Formulary |
WellCare Elite (HMO-POS)
![Email Prescription and/or Health Benefit details for WellCare Elite (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$47.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:12 /28Days | n/a |
Browse Plan Formulary |
BCN Advantage HMO ConnectedCare (HMO)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO ConnectedCare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$56.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,621.56 |
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 |
HAP Senior Plus Option 2 (PPO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 2 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$56.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $3,147.12 |
Browse Plan Formulary |
HAP Senior Plus Option 1 (HMO-POS)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 1 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$76.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $3,147.12 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$76.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | None | $4,052.64 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$76.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | None | $4,150.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$76.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | None | $4,164.96 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$76.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | None | $4,672.08 |
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 |
Medicare Plus Blue PPO Vitality (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Vitality (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$76.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | None | $4,351.44 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Merit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$85.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $3,339.60 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Merit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$85.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $3,954.00 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Merit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$85.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $3,870.24 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Merit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$85.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $3,844.32 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Merit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$85.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,676.52 |
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 |
HAP Senior Plus Henry Ford Tiered Access (HMO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Henry Ford Tiered Access (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$91.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $4,685.64 |
Browse Plan Formulary |
HumanaChoice H5216-011 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-011 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$98.00 |
$105 |
No |
5 |
Tier 5 |
31% | n/a | P Q:12 /28Days | $2,688.12 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$113.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $3,870.24 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$113.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $3,844.32 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$113.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,676.52 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$113.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $3,339.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare (HMO-POS)
![Email Prescription and/or Health Benefit details for PriorityMedicare (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$113.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $3,954.00 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$128.30 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,150.44 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$128.30 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,139.76 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$128.30 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,672.08 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$128.30 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,440.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Classic (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$128.30 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,052.64 |
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 |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$134.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,351.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$134.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,052.64 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$134.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,150.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$134.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,164.96 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Signature (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$134.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,672.08 |
Browse Plan Formulary |
HAP Senior Plus Option 3 (PPO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 3 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$149.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $3,147.12 |
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 |
HAP Senior Plus Option 2 (HMO-POS)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 2 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$181.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $3,147.12 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$196.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $3,844.32 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$196.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,676.52 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$196.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $3,339.60 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$196.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $3,954.00 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for PriorityMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$196.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $3,870.24 |
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 |
HAP Senior Plus Option 4 (PPO)
![Email Prescription and/or Health Benefit details for HAP Senior Plus Option 4 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$200.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $3,147.12 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$263.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,139.76 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$263.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,672.08 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$263.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,440.36 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$263.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,052.64 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
![Email Prescription and/or Health Benefit details for BCN Advantage HMO-POS Prestige (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$263.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,150.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$298.10 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,052.64 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$298.10 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,150.44 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$298.10 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,164.96 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$298.10 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,672.08 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
![Email Prescription and/or Health Benefit details for Medicare Plus Blue PPO Assure (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$298.10 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $4,351.44 |
Browse Plan Formulary |