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Humana Walmart Value Rx Plan (PDP)

Humana Inc.
Humana Walmart Value Rx Plan (PDP) S5884-195 Plan Details
3 out of 5 stars

Humana Walmart Value Rx Plan (PDP) is a plan offered by Humana Inc..
Plan ID: S5884-195.

$31.20
Monthly Premium

Humana Walmart Value Rx Plan (PDP) is a plan offered by Humana Inc..
Plan ID: S5884-195.

Humana Inc.
Humana Walmart Value Rx Plan (PDP) S5884-195 Plan Details
3 out of 5 stars

Humana Walmart Value Rx Plan (PDP) is a plan offered by Humana Inc..
Plan ID: S5884-195.

$31.20
Monthly Premium

Wisconsin Counties Served

Adams Brown Burnett Columbia Green Kenosha Ashland Barron Bayfield Buffalo Calumet Chippewa Clark Crawford Dane Dodge Door Douglas Dunn Eau Claire Florence Fond Du Lac Forest Gogebic Grant Green Lake Iowa Iron Jefferson Juneau Kewaunee La Crosse Lafayette Langlade Lincoln Manitowoc Marathon Marinette Marquette Menominee Milwaukee Monroe Oconto Oneida Outagamie Ozaukee Pepin Pierce Polk Portage Price Racine Richland Rock Rusk Saint Croix Sauk Sawyer Shawano Sheboygan Taylor Trempealeau Vernon Vilas Walworth Washburn Washington Waukesha Waupaca Waushara Winnebago Wood

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $505
Out of Pocket Max In-Network: $-1
Out-of-Network: N/A
Initial Coverage Limit $4660
Catastrophic Coverage Limit $7,400

Prescription Drug Costs and Coverage

The Humana Walmart Value Rx Plan (PDP) plan offers the following prescription drug coverage, with an annual drug deductible of $505 (excludes Tiers 1 and 2) per year.

Coverage
Cost
Coverage & Cost
Annual Drug Deductible $505 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share retail $0.00
  • Standard retail $10.00
  • Preferred cost-share mail order $0.00
  • Standard mail order $10.00
Generic
  • Preferred cost-share retail $2.00
  • Standard retail $20.00
  • Preferred cost-share mail order $2.00
  • Standard mail order $20.00
Annual Drug Deductible $505 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share retail N/A
  • Standard retail N/A
  • Preferred cost-share mail order N/A
  • Standard mail order N/A
Generic
  • Preferred cost-share retail N/A
  • Standard retail N/A
  • Preferred cost-share mail order N/A
  • Standard mail order N/A
Annual Drug Deductible $505 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share retail $0.00
  • Standard retail $30.00
  • Preferred cost-share mail order $0.00
  • Standard mail order $30.00
Generic
  • Preferred cost-share retail $6.00
  • Standard retail $60.00
  • Preferred cost-share mail order $6.00
  • Standard mail order $60.00
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