DEXTROAMPHETAMINE 20 MG TABLET [Zenzedi] (60 TABLETS ) (NDC: 52536052003)
2024 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
See your cost using a drug discount card: Compare prices at pharmacies near you |
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 from UHC AZ-0001 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0001 (HMO-POS)](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 | $275.00 | Q:90 /30Days | $106.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0002 (HMO-POS)](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 | $275.00 | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0002 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0002 (HMO-POS)](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 | $275.00 | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0004 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0004 (HMO-POS)](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 | $275.00 | Q:90 /30Days | $106.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0005 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0005 (HMO-POS)](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 | $275.00 | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 from UHC AZ-0005 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0005 (HMO-POS)](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 | $275.00 | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0006 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0006 (PPO)](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 |
$100.00 | $290.00 | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0006 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0006 (PPO)](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 |
$100.00 | $290.00 | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0007 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0007 (PPO)](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 |
$100.00 | $290.00 | Q:90 /30Days | $106.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0009 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0009 (PPO)](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 |
$100.00 | $290.00 | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0009 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0009 (PPO)](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 |
$100.00 | $290.00 | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
|
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 from UHC AZ-0010 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0010 (PPO)](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 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0010 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0010 (PPO)](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 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0010 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0010 (PPO)](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 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0010 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0010 (PPO)](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 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0010 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0010 (PPO)](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 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0010 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0010 (PPO)](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 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 from UHC AZ-0010 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0010 (PPO)](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 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0010 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0010 (PPO)](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 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0010 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0010 (PPO)](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 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0010 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0010 (PPO)](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 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0010 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0010 (PPO)](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 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0010 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0010 (PPO)](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 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 from UHC AZ-002P (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-002P (HMO-POS)](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 | $275.00 | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-002P (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-002P (HMO-POS)](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 | $275.00 | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Best Life Classic (HMO)
![Email Prescription and/or Health Benefit details for Blue Best Life Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:90 /30Days | $314.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Best Life Classic (HMO)
![Email Prescription and/or Health Benefit details for Blue Best Life Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:90 /30Days | $314.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Best Life Classic (HMO)
![Email Prescription and/or Health Benefit details for Blue Best Life Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:90 /30Days | $314.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Achieve Medicare (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Cigna Achieve Medicare (HMO C-SNP)](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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Cigna Achieve Medicare (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Cigna Achieve Medicare (HMO C-SNP)](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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Achieve Medicare (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Cigna Achieve Medicare (HMO C-SNP)](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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Alliance Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Alliance Medicare (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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Alliance Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Alliance Medicare (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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Alliance Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Alliance Medicare (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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Preferred Medicare (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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Cigna Preferred Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Preferred Medicare (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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Preferred Medicare (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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Savings Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Preferred Savings Medicare (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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Savings Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Preferred Savings Medicare (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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna Preferred Savings Medicare (HMO)
![Email Prescription and/or Health Benefit details for Cigna Preferred Savings Medicare (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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
![Email Prescription and/or Health Benefit details for Cigna True Choice Medicare (PPO)](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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Cigna True Choice Medicare (PPO)
![Email Prescription and/or Health Benefit details for Cigna True Choice Medicare (PPO)](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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Medicare (PPO)
![Email Prescription and/or Health Benefit details for Cigna True Choice Medicare (PPO)](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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Savings Medicare (PPO)
![Email Prescription and/or Health Benefit details for Cigna True Choice Savings Medicare (PPO)](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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Savings Medicare (PPO)
![Email Prescription and/or Health Benefit details for Cigna True Choice Savings Medicare (PPO)](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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Cigna True Choice Savings Medicare (PPO)
![Email Prescription and/or Health Benefit details for Cigna True Choice Savings Medicare (PPO)](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 |
$100.00 | $300.00 | None | $283.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dialysis Plus (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Dialysis Plus (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $5.00 | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Dialysis Plus (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Dialysis Plus (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $5.00 | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dialysis Plus (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Dialysis Plus (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $5.00 | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dialysis Plus (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Dialysis Plus (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $5.00 | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
eternalHealth Grand Give Back (HMO)
![Email Prescription and/or Health Benefit details for eternalHealth Grand Give Back (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$185 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $45.00 | Q:90 /30Days | $314.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gold Circle (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Gold Circle (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gold Circle (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Gold Circle (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Gold Circle (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Gold Circle (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Gold Circle (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Gold Circle (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Honest Care (HMO-POS)
![Email Prescription and/or Health Benefit details for Honest Care (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $5.00 | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Honest Care (HMO-POS)
![Email Prescription and/or Health Benefit details for Honest Care (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $5.00 | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Honest Care (HMO-POS)
![Email Prescription and/or Health Benefit details for Honest Care (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $5.00 | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Honest Care (HMO-POS)
![Email Prescription and/or Health Benefit details for Honest Care (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $5.00 | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H0028-021 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H0028-021 (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 |
$95.00 | $190.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-021 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H0028-021 (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 |
$95.00 | $190.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-024 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H0028-024 (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 |
$100.00 | $200.00 | Q:90 /30Days | $399.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-024 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H0028-024 (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 |
$100.00 | $200.00 | Q:90 /30Days | $399.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-027 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H0028-027 (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 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-028 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H0028-028 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H0028-028 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H0028-028 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-052 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H0028-052 (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 |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-052 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H0028-052 (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 |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-052 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H0028-052 (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 |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-062 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H0028-062 (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 | $200.00 | Q:90 /30Days | $399.17 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H2463-001 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H2463-001 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H2463-001 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H2463-001 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
![Email Prescription and/or Health Benefit details for Humana USAA Honor with Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$480 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
![Email Prescription and/or Health Benefit details for Humana USAA Honor with Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$480 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana USAA Honor with Rx (PPO)
![Email Prescription and/or Health Benefit details for Humana USAA Honor with Rx (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$480 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-137 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $198.00 | Q:90 /30Days | $365.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-137 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $198.00 | Q:90 /30Days | $365.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-137 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-137 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $198.00 | Q:90 /30Days | $365.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-137 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $198.00 | Q:90 /30Days | $365.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-137 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $198.00 | Q:90 /30Days | $365.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-137 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $198.00 | Q:90 /30Days | $365.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-137 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $198.00 | Q:90 /30Days | $365.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-137 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $198.00 | Q:90 /30Days | $365.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-137 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-137 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $198.00 | Q:90 /30Days | $365.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-137 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $198.00 | Q:90 /30Days | $365.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-137 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $198.00 | Q:90 /30Days | $365.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-137 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-137 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$500 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $198.00 | Q:90 /30Days | $365.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-260 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-260 (PPO)](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 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-260 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-260 (PPO)](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 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-260 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-260 (PPO)](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 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-263 (PPO)](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 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-263 (PPO)](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 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-263 (PPO)](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 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-263 (PPO)](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 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-263 (PPO)](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 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-263 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-263 (PPO)](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 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-263 (PPO)](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 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-263 (PPO)](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 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-263 (PPO)](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 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-263 (PPO)](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 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-263 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-263 (PPO)](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 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-263 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-263 (PPO)](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 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-265 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-265 (PPO)](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 |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-265 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-265 (PPO)](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 |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-265 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-265 (PPO)](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 |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-371 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-371 (PPO)](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 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-371 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-371 (PPO)](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 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-371 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-371 (PPO)](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 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Super Plus (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Super Plus (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $5.00 | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Super Plus (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Super Plus (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $5.00 | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Super Plus (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Super Plus (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $5.00 | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Super Plus (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Super Plus (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$5.00 | $5.00 | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care AZ-001P (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for UHC Complete Care AZ-001P (HMO-POS C-SNP)](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 | $275.00 | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
UHC Complete Care AZ-001P (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for UHC Complete Care AZ-001P (HMO-POS C-SNP)](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 | $275.00 | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care AZ-003P (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for UHC Complete Care AZ-003P (HMO-POS C-SNP)](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 | $275.00 | Q:90 /30Days | $106.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care AZ-001A (PPO C-SNP)
![Email Prescription and/or Health Benefit details for UHC Complete Care AZ-001A (PPO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care AZ-001A (PPO C-SNP)
![Email Prescription and/or Health Benefit details for UHC Complete Care AZ-001A (PPO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care AZ-001A (PPO C-SNP)
![Email Prescription and/or Health Benefit details for UHC Complete Care AZ-001A (PPO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care AZ-001A (PPO C-SNP)
![Email Prescription and/or Health Benefit details for UHC Complete Care AZ-001A (PPO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
UHC Complete Care AZ-001A (PPO C-SNP)
![Email Prescription and/or Health Benefit details for UHC Complete Care AZ-001A (PPO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Complete Care AZ-001A (PPO C-SNP)
![Email Prescription and/or Health Benefit details for UHC Complete Care AZ-001A (PPO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0013 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0013 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $106.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0013 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0013 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $106.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0013 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0013 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$20.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $106.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
Super Complete (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Super Complete (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Super Complete (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Super Complete (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Super Complete (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Super Complete (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Super Complete (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Super Complete (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0011 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0011 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$27.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $106.15 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0003 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0003 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0003 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0003 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 from UHC AZ-0012 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0012 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0012 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0012 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-224 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-224 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-224 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-224 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-224 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-224 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-224 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-224 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-224 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-224 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-023 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H0028-023 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-023 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H0028-023 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H0028-023 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H0028-023 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-198 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-198 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-198 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-198 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-198 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-198 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-198 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-198 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-198 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-198 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-198 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-198 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-198 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-198 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-198 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $374.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dialysis Complete (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Dialysis Complete (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dialysis Complete (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Dialysis Complete (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
Dialysis Complete (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Dialysis Complete (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
Dialysis Complete (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Dialysis Complete (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | Q:60 /30Days | $314.95 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan AZ-F001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan AZ-F001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:90 /30Days | $245.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan AZ-F001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan AZ-F001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:90 /30Days | $245.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan AZ-F001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan AZ-F001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:90 /30Days | $245.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan AZ-F001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan AZ-F001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | Q:90 /30Days | $245.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 from UHC AZ-0008 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0008 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0008 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0008 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0008 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0008 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0008 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0008 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0008 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0008 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0008 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0008 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 from UHC AZ-0008 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0008 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0008 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0008 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0008 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0008 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0008 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0008 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0008 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0008 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0008 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0008 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $108.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
eternalHealth Horizon (HMO)
![Email Prescription and/or Health Benefit details for eternalHealth Horizon (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$45.00 | $45.00 | Q:90 /30Days | $314.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5216-197 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5216-197 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5216-197 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5216-197 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5216-197 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Value Plus H5216-197 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5216-197 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5216-197 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5216-197 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5216-197 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5216-197 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5216-197 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 Value Plus H5216-197 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5216-197 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5216-197 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-197 (PPO)
![Email Prescription and/or Health Benefit details for Humana Value Plus H5216-197 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-S001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-S001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $225.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-S001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-S001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $225.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-S001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-S001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $225.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
UHC Dual Complete AZ-S001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-S001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $225.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-S001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-S001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $225.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-S001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-S001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $225.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-S001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-S001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $225.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-S001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-S001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $225.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-S001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-S001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $225.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
UHC Dual Complete AZ-S001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-S001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $225.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-S001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-S001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $225.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-S001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-S001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $225.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-S001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-S001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $225.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-S001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-S001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $225.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-S001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-S001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $225.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
UHC Dual Complete AZ-Y001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-Y001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-Y001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-Y001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-Y001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-Y001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-Y001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-Y001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-Y001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-Y001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-Y001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-Y001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
UHC Dual Complete AZ-Y001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-Y001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete AZ-Y001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete AZ-Y001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$43.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
15% | 15% | Q:90 /30Days | $262.76 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Best Life Plus (HMO)
![Email Prescription and/or Health Benefit details for Blue Best Life Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:90 /30Days | $314.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Best Life Plus (HMO)
![Email Prescription and/or Health Benefit details for Blue Best Life Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$45.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:90 /30Days | $314.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC AZ-0014 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC AZ-0014 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$48.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | Q:90 /30Days | $291.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueJourney (PPO)
![Email Prescription and/or Health Benefit details for BlueJourney (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$60.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:90 /30Days | $314.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 |
BlueJourney (PPO)
![Email Prescription and/or Health Benefit details for BlueJourney (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$60.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Preferred Brand |
$47.00 | $141.00 | Q:90 /30Days | $314.96 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R7220-002 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R7220-002 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$75.00 |
$540 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
25% | 25% | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-335 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$107.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-335 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$107.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-335 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$107.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-335 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$107.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-335 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-335 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$107.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-335 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$107.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-335 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$107.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-335 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$107.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-335 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$107.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-335 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$107.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-335 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-335 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$107.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-335 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$107.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-335 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$107.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-335 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$107.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-335 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-335 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$107.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $346.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-034 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-034 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$125.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
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 H5216-034 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-034 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$125.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-034 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-034 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$125.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-034 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-034 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$125.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-034 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-034 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$125.00 |
$225 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $200.00 | Q:90 /30Days | $337.45 |
Browse Plan Formulary all covered insulin pay $35 or less |