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Verified against CMS.gov · on April 2026 Plan ID: H0504-050 Cross-check on Medicare.gov →

Blue Shield Advantage (HMO)

Plan Year 2026
$20.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$340.00 Annual Deductible
966 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 ZYKADIA ceritinib Brand Tier 5 0.3% coinsurance Details
2 Dicyclomine Dicyclomine hydrochloride Brand Tier 2 $5.00 Details
3 Dicloxacillin Sodium Brand Tier 2 $5.00 Details
4 Xalkori CRIZOTINIB Brand Tier 5 0.3% coinsurance Details
5 Teflaro ceftaroline fosamil Brand Tier 5 0.3% coinsurance Details
6 Verzenio abemaciclib Brand Tier 5 0.3% coinsurance Details
7 Mekinist trametinib Brand Tier 5 0.3% coinsurance Details
8 Thioridazine Hydrochloride thioridazine hydrochloride Brand Tier 3 0.2% coinsurance Details
9 Daurismo glasdegib Brand Tier 5 0.3% coinsurance Details
10 Clozapine Brand Tier 4 0.3% coinsurance Details
11 Haloperidol Brand Tier 2 $5.00 Details
12 Pilocarpine Hydrochloride Brand Tier 3 0.2% coinsurance Details
13 Amoxicillin Brand Tier 2 $5.00 Details
14 Warfarin Sodium Brand Tier 1 $0.00 Details
15 Levothyroxine Sodium levothyroxine sodium Brand Tier 1 $0.00 Details
16 Nystatin Brand Tier 2 $5.00 Details
17 Levothyroxine Sodium levothyroxine sodium Brand Tier 1 $0.00 Details
18 Cefuroxime Brand Tier 4 0.3% coinsurance Details
19 VAQTA hepatitis A vaccine, inactivated Brand Tier 3 0.2% coinsurance Details
20 Linzess linaclotide Brand Tier 3 0.2% coinsurance Details

Showing 20 of 966 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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