LYBALVI 10-10 MG TABLET (TABLETS ) (NDC: 65757065242)
2024 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
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Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP Medicare Advantage from UHC FL-0026 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC FL-0026 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:30 /30Days | $1,723.26 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC FL-0031 (Regional PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC FL-0031 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$395 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
27% | n/a | S Q:30 /30Days | $1,698.82 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare Access (HMO-POS)
![Email Prescription and/or Health Benefit details for AvMed Medicare Access (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,475.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare Choice (HMO)
![Email Prescription and/or Health Benefit details for AvMed Medicare Choice (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,475.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
AvMed Medicare Circle (HMO)
![Email Prescription and/or Health Benefit details for AvMed Medicare Circle (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,475.86 |
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 |
AvMed Medicare One (HMO)
![Email Prescription and/or Health Benefit details for AvMed Medicare One (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,475.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Classic (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare Classic (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,563.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Premier (HMO)
![Email Prescription and/or Health Benefit details for BlueMedicare Premier (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,585.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Value (PPO)
![Email Prescription and/or Health Benefit details for BlueMedicare Value (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,551.12 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareBreeze Platinum (HMO C-SNP)
![Email Prescription and/or Health Benefit details for CareBreeze Platinum (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,498.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareComplete Platinum (HMO C-SNP)
![Email Prescription and/or Health Benefit details for CareComplete Platinum (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,498.87 |
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 |
CareFree (HMO)
![Email Prescription and/or Health Benefit details for CareFree (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,498.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareFree Platinum (HMO)
![Email Prescription and/or Health Benefit details for CareFree Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,498.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareOne Plus (HMO)
![Email Prescription and/or Health Benefit details for CareOne Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,495.86 |
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, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,512.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
DrMax-B (HMO)
![Email Prescription and/or Health Benefit details for DrMax-B (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,515.88 |
Browse Plan Formulary all covered insulin pay $35 or less |
DrValue-B (HMO)
![Email Prescription and/or Health Benefit details for DrValue-B (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,515.88 |
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 |
Freedom VIP Savings (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Freedom VIP Savings (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 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,501.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
Freedom VIP Savings COPD (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Freedom VIP Savings COPD (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 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,501.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthSun HealthAdvantage Plan (HMO)
![Email Prescription and/or Health Benefit details for HealthSun HealthAdvantage Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,476.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthSun HealthAdvantage Plus (HMO)
![Email Prescription and/or Health Benefit details for HealthSun HealthAdvantage Plus (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,476.34 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthSun VitalCare (HMO C-SNP)
![Email Prescription and/or Health Benefit details for HealthSun VitalCare (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,482.49 |
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, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,512.68 |
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 - Diabetes and Heart (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus - Diabetes and Heart (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,495.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-065C (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-065C (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,495.86 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H1036-305 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H1036-305 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,495.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus Lung (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus Lung (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,495.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice Florida H5216-068 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice Florida H5216-068 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,495.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice Florida H5216-311 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice Florida H5216-311 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,486.93 |
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 Florida H7284-008 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice Florida H7284-008 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,495.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Optimum Gold Rewards Plan (HMO)
![Email Prescription and/or Health Benefit details for Optimum Gold Rewards Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,502.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Optimum Platinum Plan (HMO)
![Email Prescription and/or Health Benefit details for Optimum Platinum Plan (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
4 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,502.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Comfort (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Simply Comfort (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$545 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
25% | n/a | Q:30 /30Days | $1,542.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra (HMO)
![Email Prescription and/or Health Benefit details for Simply Extra (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,542.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Extra Platinum (HMO)
![Email Prescription and/or Health Benefit details for Simply Extra Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,542.13 |
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 |
Simply Freedom (PPO)
![Email Prescription and/or Health Benefit details for Simply Freedom (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$125 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
31% | n/a | Q:30 /30Days | $1,541.94 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Simply Level (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,542.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Level Platinum (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Simply Level Platinum (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,542.13 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More (HMO)
![Email Prescription and/or Health Benefit details for Simply More (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,542.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply More Platinum (HMO)
![Email Prescription and/or Health Benefit details for Simply More Platinum (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | Q:30 /30Days | $1,542.13 |
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, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | P Q:30 /30Days | $1,512.68 |
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 MedicareMax Complete Care FL-0030 (HMO C-SNP)
![Email Prescription and/or Health Benefit details for UHC MedicareMax Complete Care FL-0030 (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:30 /30Days | $1,732.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC MedicareMax Medicare Advantage FL-0029 (HMO)
![Email Prescription and/or Health Benefit details for UHC MedicareMax Medicare Advantage FL-0029 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:30 /30Days | $1,745.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Preferred Medicare Advantage FL-0002 (HMO)
![Email Prescription and/or Health Benefit details for UHC Preferred Medicare Advantage FL-0002 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
33% | n/a | S Q:30 /30Days | $1,745.02 |
Browse Plan Formulary all covered insulin pay $35 or less |
Freedom Medi-Medi Full (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Freedom Medi-Medi Full (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$16.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
25% | n/a | Q:30 /30Days | $1,501.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthSun MediSun Extra (HMO D-SNP)
![Email Prescription and/or Health Benefit details for HealthSun MediSun Extra (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$19.80 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:30 /30Days | $1,501.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
HealthSun MediMax (HMO)
![Email Prescription and/or Health Benefit details for HealthSun MediMax (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$23.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:30 /30Days | $1,501.37 |
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 |
Optimum Emerald Partial (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Optimum Emerald Partial (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$24.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
25% | n/a | Q:30 /30Days | $1,501.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice Florida H7284-007 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice Florida H7284-007 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P Q:30 /30Days | $1,486.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
Optimum Emerald Full (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Optimum Emerald Full (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
25% | n/a | Q:30 /30Days | $1,501.59 |
Browse Plan Formulary all covered insulin pay $35 or less |
DrPlus-B (HMO D-SNP)
![Email Prescription and/or Health Benefit details for DrPlus-B (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,515.88 |
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 |
5 |
Tier 5 |
25% | 25% | P Q:30 /30Days | $1,512.68 |
Browse Plan Formulary all covered insulin pay $35 or less |
Freedom Medi-Medi Partial (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Freedom Medi-Medi Partial (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Specialty Tier |
25% | n/a | Q:30 /30Days | $1,501.59 |
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 Fully Integrated H1036-280 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Fully Integrated H1036-280 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:30 /30Days | $1,489.89 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R5826-074 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-074 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.00 |
$395 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
27% | n/a | P Q:30 /30Days | $1,487.87 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Nursing Home Plan FL-F001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan FL-F001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | S Q:30 /30Days | $1,699.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareNeeds Platinum (HMO D-SNP)
![Email Prescription and/or Health Benefit details for CareNeeds Platinum (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$32.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:30 /30Days | $1,495.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
CareNeeds Plus (HMO D-SNP)
![Email Prescription and/or Health Benefit details for CareNeeds Plus (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$34.20 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:30 /30Days | $1,495.64 |
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) |
$36.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | 25% | P Q:30 /30Days | $1,512.68 |
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 |
AmeriHealth Caritas VIP Care (HMO D-SNP)
![Email Prescription and/or Health Benefit details for AmeriHealth Caritas VIP Care (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | P | $1,528.33 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Complete (HMO D-SNP)
![Email Prescription and/or Health Benefit details for BlueMedicare Complete (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P Q:30 /30Days | $1,551.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:30 /30Days | $1,495.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:30 /30Days | $1,495.64 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice Florida SNP-DE H7284-010 (PPO D-SNP)
![Email Prescription and/or Health Benefit details for HumanaChoice Florida SNP-DE H7284-010 (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P Q:30 /30Days | $1,486.93 |
Browse Plan Formulary all covered insulin pay $35 or less |
Longevity Health Plan (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Longevity Health Plan (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | S Q:30 /30Days | $1,483.44 |
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 |
Simply Complete (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Simply Complete (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:30 /30Days | $1,538.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simply Complete Platinum (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Simply Complete Platinum (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | Q:30 /30Days | $1,539.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Care Advantage FL-E001 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Care Advantage FL-E001 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.70 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | S Q:30 /30Days | $1,699.99 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete FL-D003 (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S Q:30 /30Days | $1,692.75 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D003 (PPO D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete FL-D003 (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S Q:30 /30Days | $1,722.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete FL-D005 (Regional PPO D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete FL-D005 (Regional PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S Q:30 /30Days | $1,698.82 |
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 MedicareMax Medicare Advantage FL-D004 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for UHC MedicareMax Medicare Advantage FL-D004 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S Q:30 /30Days | $1,732.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Preferred Dual Complete FL-D001 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for UHC Preferred Dual Complete FL-D001 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$37.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | S Q:30 /30Days | $1,732.16 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Choice (Regional PPO)
![Email Prescription and/or Health Benefit details for BlueMedicare Choice (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$67.40 |
$250 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
29% | n/a | P Q:30 /30Days | $1,541.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
BlueMedicare Select (PPO)
![Email Prescription and/or Health Benefit details for BlueMedicare Select (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$97.70 |
$305 |
Yes, but No Gap Coverage for this drug. |
5 |
Tier 5 |
28% | n/a | P Q:30 /30Days | $1,546.37 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R5826-005 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R5826-005 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$173.00 |
$100 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
31% | n/a | P Q:30 /30Days | $1,487.87 |
Browse Plan Formulary all covered insulin pay $35 or less |