ORKAMBI 200 MG-125 MG TABLET (112 EA ) (NDC: 51167080901)
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 |
AARP Medicare Advantage SecureHorizons Focus (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Focus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P Q:112 /28Days | $23,875.20 |
Browse Plan Formulary |
AARP Medicare Advantage SecureHorizons Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P Q:112 /28Days | $23,875.20 |
Browse Plan Formulary |
AARP Medicare Advantage SecureHorizons Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P Q:112 /28Days | $23,875.20 |
Browse Plan Formulary |
Aetna Medicare Plus Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Plus Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,726.80 |
Browse Plan Formulary |
Aetna Medicare Prime Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Prime Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,726.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,726.80 |
Browse Plan Formulary |
Alignment Health Plan Heart & Diabetes (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Alignment Health Plan Heart & Diabetes (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,592.40 |
Browse Plan Formulary |
Alignment Health Plan My Choice (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan My Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,592.40 |
Browse Plan Formulary |
Alignment Health Plan Platinum (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,592.40 |
Browse Plan Formulary |
Alignment Health Plan smartHMO (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan smartHMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,579.20 |
Browse Plan Formulary |
Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P Q:120 /30Days | $23,816.40 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem MediBlue Breathe (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Breathe (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,122.00 |
Browse Plan Formulary |
Anthem MediBlue Care On Site (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Care On Site (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,122.00 |
Browse Plan Formulary |
Anthem MediBlue Connect (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Connect (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:120 /30Days | $22,122.00 |
Browse Plan Formulary |
Anthem MediBlue Diabetes (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Diabetes (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,122.00 |
Browse Plan Formulary |
Anthem MediBlue ESRD (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue ESRD (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,122.00 |
Browse Plan Formulary |
Anthem MediBlue Heart (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Heart (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,122.00 |
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 |
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) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $23,719.20 |
Browse Plan Formulary |
Anthem MediBlue Select (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $24,397.20 |
Browse Plan Formulary |
Anthem MediBlue StartSmart Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue StartSmart Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,122.00 |
Browse Plan Formulary |
Anthem MediBlue Value Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Value Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,122.00 |
Browse Plan Formulary |
Blue Shield Promise AdvantageOptimum Plan (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield Promise AdvantageOptimum Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $21,584.40 |
Browse Plan Formulary |
Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
3 |
Tier 3 |
0% | 0% | P | $22,974.00 |
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 |
Central Health Focus Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Central Health Focus Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,705.20 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
![Email Prescription and/or Health Benefit details for Central Health Medicare Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,705.20 |
Browse Plan Formulary |
Connected Care (HMO)
![Email Prescription and/or Health Benefit details for Connected Care (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | 15% | P Q:112 /28Days | $22,665.60 |
Browse Plan Formulary |
Connected Care Select (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Connected Care Select (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | 15% | P Q:112 /28Days | $22,665.60 |
Browse Plan Formulary |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P | $23,834.40 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
![Email Prescription and/or Health Benefit details for Health Net Gold Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $24,379.20 |
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 |
Health Net Gold Select (HMO)
![Email Prescription and/or Health Benefit details for Health Net Gold Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $23,378.40 |
Browse Plan Formulary |
Health Net Jade (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Health Net Jade (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $23,378.40 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Sapphire (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$370 |
No |
5 |
Tier 5 |
26% | n/a | P | $23,719.20 |
Browse Plan Formulary |
Humana Gold Plus H5619-021 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5619-021 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:112 /28Days | $23,274.00 |
Browse Plan Formulary |
Imperial Senior Value (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Imperial Senior Value (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,699.20 |
Browse Plan Formulary |
Imperial Traditional (HMO) (HMO)
![Email Prescription and/or Health Benefit details for Imperial Traditional (HMO) (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,699.20 |
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 |
Inter Valley Health Plan Service To Seniors (HMO)
![Email Prescription and/or Health Benefit details for Inter Valley Health Plan Service To Seniors (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,345.20 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | None | $23,498.40 |
Browse Plan Formulary |
L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for L.A. Care Cal MediConnect 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:120 /30Days | $22,974.00 |
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 | $23,913.60 |
Browse Plan Formulary |
PHP (HMO C-SNP)
![Email Prescription and/or Health Benefit details for PHP (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$435 |
No |
4 |
Tier 4 |
25% | n/a | P Q:120 /30Days | $22,710.00 |
Browse Plan Formulary |
SCAN Balance (HMO C-SNP)
![Email Prescription and/or Health Benefit details for SCAN Balance (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P | $21,397.20 |
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 |
SCAN Classic (HMO)
![Email Prescription and/or Health Benefit details for SCAN Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,447.20 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO I-SNP)
![Email Prescription and/or Health Benefit details for SCAN Healthy at Home (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $21,397.20 |
Browse Plan Formulary |
WellCare Best (HMO)
![Email Prescription and/or Health Benefit details for WellCare Best (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $24,927.60 |
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 |
No |
5 |
Tier 5 |
33% | n/a | P | $24,927.60 |
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) |
$0.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $24,730.80 |
Browse Plan Formulary |
WellCare Freedom (HMO D-SNP)
![Email Prescription and/or Health Benefit details for WellCare Freedom (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$1.10 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $24,730.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
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) |
$14.40 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:120 /30Days | $23,719.20 |
Browse Plan Formulary |
UnitedHealthcare Medicare Advantage Assure (HMO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Assure (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.90 |
$435 |
No |
5 |
Tier 5 |
25% | 25% | P Q:112 /28Days | $23,278.80 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage B Only South (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$15.40 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | None | $23,498.40 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
![Email Prescription and/or Health Benefit details for Health Net Healthy Heart (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $24,379.20 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
![Email Prescription and/or Health Benefit details for Health Net Healthy Heart (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $23,378.40 |
Browse Plan Formulary |
Humana Value Plus H5619-037 (HMO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5619-037 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.80 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:112 /28Days | $23,274.00 |
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 |
AARP Medicare Advantage SecureHorizons Premier (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.70 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P Q:112 /28Days | $23,875.20 |
Browse Plan Formulary |
Anthem MediBlue Connect Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Connect Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.20 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:120 /30Days | $22,122.00 |
Browse Plan Formulary |
SCAN Prime (HMO)
![Email Prescription and/or Health Benefit details for SCAN Prime (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,447.20 |
Browse Plan Formulary |
Anthem MediBlue Coordination Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Coordination Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.30 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:120 /30Days | $23,719.20 |
Browse Plan Formulary |
Alignment Health Plan CalPlus (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan CalPlus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.30 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:120 /30Days | $22,485.60 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.10 |
$435 |
No |
5 |
Tier 5 |
15% | 15% | None | $23,498.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP Medicare Advantage SecureHorizons Focus (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Focus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P Q:112 /28Days | $23,875.20 |
Browse Plan Formulary |
AARP Medicare Advantage SecureHorizons Plan 1 (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Plan 1 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P Q:112 /28Days | $23,875.20 |
Browse Plan Formulary |
AARP Medicare Advantage SecureHorizons Plan 2 (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Plan 2 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P Q:112 /28Days | $23,875.20 |
Browse Plan Formulary |
AARP Medicare Advantage SecureHorizons Premier (HMO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage SecureHorizons Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | P Q:112 /28Days | $23,875.20 |
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) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $23,974.80 |
Browse Plan Formulary |
Aetna Medicare Plus Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Plus Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,726.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Prime Plan (HMO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Prime Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,726.80 |
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) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,726.80 |
Browse Plan Formulary |
Alignment Health Plan CalPlus (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan CalPlus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:120 /30Days | $22,485.60 |
Browse Plan Formulary |
Alignment Health Plan Heart & Diabetes (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Alignment Health Plan Heart & Diabetes (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,592.40 |
Browse Plan Formulary |
Alignment Health Plan My Choice (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan My Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,592.40 |
Browse Plan Formulary |
Alignment Health Plan Platinum (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,592.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Alignment Health Plan smartHMO (HMO)
![Email Prescription and/or Health Benefit details for Alignment Health Plan smartHMO (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,579.20 |
Browse Plan Formulary |
Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P Q:120 /30Days | $23,816.40 |
Browse Plan Formulary |
Anthem MediBlue Breathe (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Breathe (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,122.00 |
Browse Plan Formulary |
Anthem MediBlue Care On Site (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Care On Site (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,122.00 |
Browse Plan Formulary |
Anthem MediBlue Connect (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Connect (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:120 /30Days | $22,122.00 |
Browse Plan Formulary |
Anthem MediBlue Connect Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Connect Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:120 /30Days | $22,122.00 |
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 |
Anthem MediBlue Coordination Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Coordination Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:120 /30Days | $23,719.20 |
Browse Plan Formulary |
Anthem MediBlue Diabetes (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Diabetes (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,122.00 |
Browse Plan Formulary |
Anthem MediBlue ESRD (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue ESRD (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,122.00 |
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) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:120 /30Days | $23,719.20 |
Browse Plan Formulary |
Anthem MediBlue Heart (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Heart (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,122.00 |
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) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $23,719.20 |
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 |
Anthem MediBlue Select (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $24,397.20 |
Browse Plan Formulary |
Anthem MediBlue StartSmart Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue StartSmart Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,122.00 |
Browse Plan Formulary |
Anthem MediBlue Value Plus (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Value Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,122.00 |
Browse Plan Formulary |
Blue Shield Promise AdvantageOptimum Plan (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield Promise AdvantageOptimum Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $21,584.40 |
Browse Plan Formulary |
Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
3 |
Tier 3 |
0% | 0% | P | $22,974.00 |
Browse Plan Formulary |
Blue Shield Promise Coordinated Choice Plan (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield Promise Coordinated Choice Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $21,853.20 |
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 |
Blue Shield Promise Coordinated Choice Plan (HMO)
![Email Prescription and/or Health Benefit details for Blue Shield Promise Coordinated Choice Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $21,853.20 |
Browse Plan Formulary |
Blue Shield Promise TotalDual Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Blue Shield Promise TotalDual Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $22,974.00 |
Browse Plan Formulary |
Blue Shield Promise TotalDual Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Blue Shield Promise TotalDual Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $22,974.00 |
Browse Plan Formulary |
Central Health Focus Plan (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Central Health Focus Plan (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,705.20 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Central Health Medi-Medi Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:120 /30Days | $22,705.20 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Central Health Medi-Medi Plan (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:120 /30Days | $22,705.20 |
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 |
Central Health Medicare Plan (HMO)
![Email Prescription and/or Health Benefit details for Central Health Medicare Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $22,705.20 |
Browse Plan Formulary |
Central Health Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Central Health Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:120 /30Days | $22,705.20 |
Browse Plan Formulary |
Central Health Premier Plan (HMO)
![Email Prescription and/or Health Benefit details for Central Health Premier Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:120 /30Days | $22,705.20 |
Browse Plan Formulary |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P | $23,834.40 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
![Email Prescription and/or Health Benefit details for Health Net Gold Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $24,379.20 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
![Email Prescription and/or Health Benefit details for Health Net Gold Select (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $23,378.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Healthy Heart (HMO)
![Email Prescription and/or Health Benefit details for Health Net Healthy Heart (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $24,379.20 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
![Email Prescription and/or Health Benefit details for Health Net Healthy Heart (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $23,378.40 |
Browse Plan Formulary |
Health Net Jade (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Health Net Jade (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $23,378.40 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Amber I (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$350 |
No |
5 |
Tier 5 |
26% | n/a | P | $23,719.20 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Amber I (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$350 |
No |
5 |
Tier 5 |
26% | n/a | P | $23,719.20 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Amber II (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$350 |
No |
5 |
Tier 5 |
26% | n/a | P | $23,719.20 |
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 |
Health Net Seniority Plus Amber II (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Amber II (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$350 |
No |
5 |
Tier 5 |
26% | n/a | P | $23,719.20 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Sapphire (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$370 |
No |
5 |
Tier 5 |
26% | n/a | P | $23,719.20 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire Premier (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Sapphire Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$370 |
No |
5 |
Tier 5 |
26% | n/a | P | $23,719.20 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire Premier (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Sapphire Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$370 |
No |
5 |
Tier 5 |
26% | n/a | P | $23,719.20 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire Premier II (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Sapphire Premier II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$410 |
No |
5 |
Tier 5 |
25% | n/a | P | $23,719.20 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire Premier II (HMO)
![Email Prescription and/or Health Benefit details for Health Net Seniority Plus Sapphire Premier II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$410 |
No |
5 |
Tier 5 |
25% | n/a | P | $23,719.20 |
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 H5619-021 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5619-021 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:112 /28Days | $23,274.00 |
Browse Plan Formulary |
Humana Value Plus H5619-037 (HMO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5619-037 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:112 /28Days | $23,274.00 |
Browse Plan Formulary |
Imperial Senior Value (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Imperial Senior Value (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,699.20 |
Browse Plan Formulary |
Imperial Traditional (HMO) (HMO)
![Email Prescription and/or Health Benefit details for Imperial Traditional (HMO) (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,699.20 |
Browse Plan Formulary |
Imperial Traditional Plus (HMO) (HMO)
![Email Prescription and/or Health Benefit details for Imperial Traditional Plus (HMO) (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $22,699.20 |
Browse Plan Formulary |
Imperial Traditional Plus (HMO) (HMO)
![Email Prescription and/or Health Benefit details for Imperial Traditional Plus (HMO) (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $22,699.20 |
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 |
Inter Valley Health Plan Vitality Plus (HMO)
![Email Prescription and/or Health Benefit details for Inter Valley Health Plan Vitality Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $22,345.20 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage B Only South (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | None | $23,498.40 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
![Email Prescription and/or Health Benefit details for Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | 33% | None | $23,498.40 |
Browse Plan Formulary |
L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P Q:120 /30Days | $22,974.00 |
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) |
$32.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P | $23,913.60 |
Browse Plan Formulary |
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) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $21,853.20 |
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 |
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) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $21,853.20 |
Browse Plan Formulary |
PHP (HMO C-SNP)
![Email Prescription and/or Health Benefit details for PHP (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
4 |
Tier 4 |
25% | n/a | P Q:120 /30Days | $22,710.00 |
Browse Plan Formulary |
SCAN Balance (HMO C-SNP)
![Email Prescription and/or Health Benefit details for SCAN Balance (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P | $21,397.20 |
Browse Plan Formulary |
SCAN Classic (HMO)
![Email Prescription and/or Health Benefit details for SCAN Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,447.20 |
Browse Plan Formulary |
SCAN Classic II (HMO)
![Email Prescription and/or Health Benefit details for SCAN Classic II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,447.20 |
Browse Plan Formulary |
SCAN Connections (HMO D-SNP)
![Email Prescription and/or Health Benefit details for SCAN Connections (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $22,447.20 |
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 |
SCAN Connections (HMO D-SNP)
![Email Prescription and/or Health Benefit details for SCAN Connections (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $22,447.20 |
Browse Plan Formulary |
SCAN Connections at Home (HMO D-SNP)
![Email Prescription and/or Health Benefit details for SCAN Connections at Home (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $22,447.20 |
Browse Plan Formulary |
SCAN Connections at Home (HMO D-SNP)
![Email Prescription and/or Health Benefit details for SCAN Connections at Home (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $22,447.20 |
Browse Plan Formulary |
SCAN Healthy at Home (HMO I-SNP)
![Email Prescription and/or Health Benefit details for SCAN Healthy at Home (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $21,397.20 |
Browse Plan Formulary |
SCAN Plus (HMO)
![Email Prescription and/or Health Benefit details for SCAN Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $21,397.20 |
Browse Plan Formulary |
SCAN Plus (HMO)
![Email Prescription and/or Health Benefit details for SCAN Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $21,397.20 |
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 |
SCAN Prime (HMO)
![Email Prescription and/or Health Benefit details for SCAN Prime (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,447.20 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
15% | 15% | None | $23,498.40 |
Browse Plan Formulary |
UnitedHealthcare Medicare Advantage Assure (HMO)
![Email Prescription and/or Health Benefit details for UnitedHealthcare Medicare Advantage Assure (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | 25% | P Q:112 /28Days | $23,278.80 |
Browse Plan Formulary |
VillageHealth (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for VillageHealth (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $21,397.20 |
Browse Plan Formulary |
VillageHealth (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for VillageHealth (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $21,397.20 |
Browse Plan Formulary |
WellCare Best (HMO)
![Email Prescription and/or Health Benefit details for WellCare Best (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $24,927.60 |
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 |
WellCare Dividend (HMO)
![Email Prescription and/or Health Benefit details for WellCare Dividend (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $24,927.60 |
Browse Plan Formulary |
WellCare Freedom (HMO D-SNP)
![Email Prescription and/or Health Benefit details for WellCare Freedom (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $24,730.80 |
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) |
$32.00 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $24,730.80 |
Browse Plan Formulary |
SCAN Classic II (HMO)
![Email Prescription and/or Health Benefit details for SCAN Classic II (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $22,447.20 |
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 |
No |
5 |
Tier 5 |
33% | n/a | P | $23,974.80 |
Browse Plan Formulary |