AMABELZ 1 MG-0.5 MG TABLET [Mimvey] (28 TABLETS ) (NDC: 68180083073)
2022 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 Medicare Premier (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $46.76 |
Browse Plan Formulary |
Aetna Medicare Value Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Value Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $141.00 | None | $76.16 |
Browse Plan Formulary |
Anthem MediBlue Preferred (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P | $72.24 |
Browse Plan Formulary |
Anthem MediBlue Preferred (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P | $72.24 |
Browse Plan Formulary |
Anthem MediBlue Preferred (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P | $91.28 |
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 Preferred (HMO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P | $72.24 |
Browse Plan Formulary |
Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics, All Brands |
2 |
Tier 2 |
0% | 0% | None | $59.08 |
Browse Plan Formulary |
CareSource Advantage Zero Premium (HMO)
![Email Prescription and/or Health Benefit details for CareSource Advantage Zero Premium (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$175 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | P | $19.04 |
Browse Plan Formulary |
Humana Gold Plus H6622-013 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-013 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $104.72 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Humana Gold Plus H6622-021 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-021 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | None | $86.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Humana Gold Plus H6622-021 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-021 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | None | $104.72 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-285 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-285 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $86.80 |
Browse Plan Formulary |
HumanaChoice H5525-042 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5525-042 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $86.80 |
Browse Plan Formulary |
MediGold Essential Care (HMO)
![Email Prescription and/or Health Benefit details for MediGold Essential Care (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $111.16 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
MediGold Essential Care (HMO)
![Email Prescription and/or Health Benefit details for MediGold Essential Care (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $111.16 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
MediGold Essential Care (HMO)
![Email Prescription and/or Health Benefit details for MediGold Essential Care (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $111.16 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
MediGold Prime Choice (PPO)
![Email Prescription and/or Health Benefit details for MediGold Prime Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $102.48 |
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 |
MedMutual Advantage Access (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Access (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $77.00 |
Browse Plan Formulary |
MedMutual Advantage Access (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Access (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $72.80 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $77.00 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $72.80 |
Browse Plan Formulary |
MedMutual Advantage Classic (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $72.80 |
Browse Plan Formulary |
MedMutual Advantage Signature (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Signature (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $77.00 |
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 |
MedMutual Advantage Signature (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Signature (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $72.80 |
Browse Plan Formulary |
MedMutual Advantage Signature (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Signature (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $72.80 |
Browse Plan Formulary |
Molina Dual Options MyCare Ohio (Medicare-Medicaid Plan)
![Email Prescription and/or Health Benefit details for Molina Dual Options MyCare Ohio (Medicare-Medicaid Plan)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
All Generics, All Brands |
2 |
Tier 2 |
0% | 0% | None | $102.48 |
Browse Plan Formulary |
Molina Medicare Choice Care (HMO)
![Email Prescription and/or Health Benefit details for Molina Medicare Choice Care (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $102.48 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Wellcare Giveback (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Giveback (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$37.00 | $74.00 | None | $86.80 |
Browse Plan Formulary |
Wellcare Giveback Boost (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Giveback Boost (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$75 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$37.00 | $74.00 | None | $86.80 |
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 |
Wellcare No Premium (HMO)
![Email Prescription and/or Health Benefit details for Wellcare No Premium (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$75 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$37.00 | $74.00 | None | $86.80 |
Browse Plan Formulary |
Wellcare No Premium Medicare (HMO)
![Email Prescription and/or Health Benefit details for Wellcare No Premium Medicare (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$75 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$37.00 | $74.00 | None | $86.80 |
Browse Plan Formulary |
Wellcare No Premium Open (PPO)
![Email Prescription and/or Health Benefit details for Wellcare No Premium Open (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$160 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$37.00 | $74.00 | None | $86.80 |
Browse Plan Formulary |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus - Diabetes and Heart (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.00 |
$200 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $86.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Wellcare Assist (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Assist (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.80 |
$480 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $102.48 |
Browse Plan Formulary |
Wellcare Assist Complement (HMO)
![Email Prescription and/or Health Benefit details for Wellcare Assist Complement (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.60 |
$480 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $102.48 |
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 |
HumanaChoice H5216-109 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-109 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $86.80 |
Browse Plan Formulary |
Humana Gold Plus H6622-055 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-055 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $86.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
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) |
$22.00 |
$480 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P | $91.28 |
Browse Plan Formulary |
Aetna Medicare Assure 1 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Assure 1 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.20 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $46.76 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.60 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $86.80 |
Browse Plan Formulary |
CareSource Advantage (HMO)
![Email Prescription and/or Health Benefit details for CareSource Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $90.00 | P | $19.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MedMutual Advantage Secure (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Secure (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $77.00 |
Browse Plan Formulary |
MedMutual Advantage Secure (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Secure (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $72.80 |
Browse Plan Formulary |
Wellcare Dual Access (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Wellcare Dual Access (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.00 |
$480 |
Some Generics |
3 |
Preferred Brand |
$40.00 | $80.00 | None | $102.48 |
Browse Plan Formulary |
Aetna Medicare Premier Plus 2 (Regional PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plus 2 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.40 |
$260 |
No |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $46.76 |
Browse Plan Formulary |
Anthem MediBlue Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $285.00 | P | $91.28 |
Browse Plan Formulary |
CareSource Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for CareSource Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
25% | 25% | P | $19.04 |
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 |
CommuniCare Advantage ISNP (HMO I-SNP)
![Email Prescription and/or Health Benefit details for CommuniCare Advantage ISNP (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $105.56 |
Browse Plan Formulary |
CommuniCare Advantage ISNP (HMO I-SNP)
![Email Prescription and/or Health Benefit details for CommuniCare Advantage ISNP (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $33.60 |
Browse Plan Formulary |
CommuniCare Advantage ISNP (HMO I-SNP)
![Email Prescription and/or Health Benefit details for CommuniCare Advantage ISNP (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $33.60 |
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) |
$33.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$44.00 | $132.00 | None | $102.48 |
Browse Plan Formulary |
Valor Health Plan (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Valor Health Plan (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.50 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $105.56 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $77.00 |
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 |
MedMutual Advantage Choice (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $72.80 |
Browse Plan Formulary |
MedMutual Advantage Choice (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$40.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $72.80 |
Browse Plan Formulary |
Anthem MediBlue Access Basic (Regional PPO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Access Basic (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$41.50 |
$200 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
41% | 41% | P | $91.28 |
Browse Plan Formulary |
Aetna Medicare Premier Plus 1 (Regional PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plus 1 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$44.50 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $126.00 | None | $46.76 |
Browse Plan Formulary |
HumanaChoice R5495-002 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5495-002 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$47.80 |
$480 |
No |
4 |
Non-Preferred Drug |
20% | 20% | None | $86.80 |
Browse Plan Formulary |
MediGold True Advantage (HMO)
![Email Prescription and/or Health Benefit details for MediGold True Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$49.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $111.16 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MedMutual Advantage Select (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $77.00 |
Browse Plan Formulary |
MedMutual Advantage Select (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $72.80 |
Browse Plan Formulary |
MedMutual Advantage Select (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$50.00 |
$95 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $72.80 |
Browse Plan Formulary |
Anthem MediBlue Access (PPO)
![Email Prescription and/or Health Benefit details for Anthem MediBlue Access (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$56.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P | $91.28 |
Browse Plan Formulary |
MediGold Flexible Choice (PPO)
![Email Prescription and/or Health Benefit details for MediGold Flexible Choice (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$57.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $94.00 | None | $102.48 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H5216-023 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-023 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$58.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $86.80 |
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 |
MedMutual Advantage Preferred (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$80.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $77.00 |
Browse Plan Formulary |
MedMutual Advantage Preferred (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$80.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $72.80 |
Browse Plan Formulary |
MedMutual Advantage Preferred (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Preferred (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$80.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $72.80 |
Browse Plan Formulary |
Humana Gold Choice H8145-032 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-032 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$83.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $86.80 |
Browse Plan Formulary |
Humana Gold Plus H6622-019 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-019 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$91.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | None | $86.80 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
MedMutual Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$97.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $72.80 |
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 |
MedMutual Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$97.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $77.00 |
Browse Plan Formulary |
MedMutual Advantage Plus (HMO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$97.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $72.80 |
Browse Plan Formulary |
Aetna Medicare Premier 2 (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier 2 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$118.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $46.76 |
Browse Plan Formulary |
MediGold Classic Preferred (HMO)
![Email Prescription and/or Health Benefit details for MediGold Classic Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $111.16 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
MediGold Classic Preferred (HMO)
![Email Prescription and/or Health Benefit details for MediGold Classic Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $111.16 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
MediGold Classic Preferred (HMO)
![Email Prescription and/or Health Benefit details for MediGold Classic Preferred (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$120.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$45.00 | $90.00 | None | $111.16 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MedMutual Advantage Premium (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Premium (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$136.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $77.00 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Premium (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$136.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $72.80 |
Browse Plan Formulary |
MedMutual Advantage Premium (PPO)
![Email Prescription and/or Health Benefit details for MedMutual Advantage Premium (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$136.00 |
$55 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$42.00 | $110.00 | P | $72.80 |
Browse Plan Formulary |
Aetna Medicare Premier 1 (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier 1 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$149.00 |
$150* |
Yes, but No Gap Coverage for this drug. |
3* |
Preferred Brand |
$47.00 | $141.00 | None | $46.76 |
Browse Plan Formulary |
HumanaChoice H5525-030 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5525-030 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$151.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$97.00 | $281.00 | None | $86.80 |
Browse Plan Formulary |