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Humana Walmart Value Rx Plan (PDP)

Humana Inc.
Humana Walmart Value Rx Plan (PDP) S5884-209 Plan Details
3 out of 5 stars

Humana Walmart Value Rx Plan (PDP) is a plan offered by Humana Inc..
Plan ID: S5884-209.

$30.60
Monthly Premium

Humana Walmart Value Rx Plan (PDP) is a plan offered by Humana Inc..
Plan ID: S5884-209.

Humana Inc.
Humana Walmart Value Rx Plan (PDP) S5884-209 Plan Details
3 out of 5 stars

Humana Walmart Value Rx Plan (PDP) is a plan offered by Humana Inc..
Plan ID: S5884-209.

$30.60
Monthly Premium

Oregon Counties Served

Baker Clackamas Deschutes Malheur Benton Clatsop Columbia Coos Crook Curry Douglas Gilliam Grant Harney Hood River Jackson Jefferson Josephine Klamath Lake Lane Lincoln Linn Marion Morrow Multnomah Polk Sherman Tillamook Umatilla Union Wallowa Wasco Washington Wheeler Yamhill

Washington Counties Served

Adams Benton Clark King Mason Pierce Skagit Spokane Asotin Benewah Chelan Columbia Cowlitz Douglas Ferry Franklin Garfield Grant Grays Harbor Island Jefferson Kitsap Kittitas Klickitat Lewis Lincoln Okanogan Pacific Pend Oreille San Juan Snohomish Stevens Thurston Umatilla Wahkiakum Walla Walla Whatcom Whitman Yakima

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 $1.00
  • Standard retail $10.00
  • Preferred cost-share mail order $1.00
  • 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 $3.00
  • 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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