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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H4931-007 Cross-check on Medicare.gov →

Banner Medicare Advantage Dual (HMO D-SNP)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00 Annual Deductible
968 Drugs Covered
1 States Served

Top Covered Drugs

Most popular medications covered by this plan, ordered by national search frequency. Click any drug to see exact copay, restrictions, and alternatives.

# Drug Name Type Tier 30-Day Copay
1 Abrysvo Respiratory Syncytial Virus Vaccine Brand Tier 1 $0.00 Details
2 Ibrance palbociclib Brand Tier 5 $0.00 Details
3 RotaTeq Rotavirus Vaccine, Live, Oral, Pentavalent Brand Tier 3 $0.00 Details
4 JANUVIA sitagliptin Brand Tier 3 $0.00 Details
5 Haloperidol Brand Tier 2 $0.00 Details
6 Pilocarpine Hydrochloride Brand Tier 4 $0.00 Details
7 Warfarin Sodium Brand Tier 1 $0.00 Details
8 Cyclosporine Modified Modified Cyclosporine Brand Tier 3 $0.00 Details
9 NITROGLYCERIN nitroglycerin Brand Tier 3 $0.00 Details
10 RETEVMO selpercatinib Brand Tier 5 $0.00 Details
11 Diltiazem Hydrochloride Brand Tier 2 $0.00 Details
12 JAYPIRCA pirtobrutinib Brand Tier 5 $0.00 Details
13 Trifluoperazine Hydrochloride trifluoperazine hydrochloride Brand Tier 3 $0.00 Details
14 Amoxicillin Brand Tier 2 $0.00 Details
15 VAQTA hepatitis A vaccine, inactivated Brand Tier 3 $0.00 Details
16 Budesonide Brand Tier 4 $0.00 Details
17 PredniSONE Brand Tier 1 $0.00 Details
18 PODOFILOX Brand Tier 3 $0.00 Details
19 JANUVIA sitagliptin Brand Tier 3 $0.00 Details
20 Clotrimazole clotrimazole Brand Tier 2 $0.00 Details

Showing 20 of 968 covered drugs.

Compare this plan against others for your medications Enter your drugs and ZIP to see personalized out-of-pocket costs.
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States Served (1)

This plan is available to Medicare beneficiaries in the following states.

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