Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP)
$22.70 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00
Annual Deductible
979
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 | Rufinamide | Brand | Tier 1 | $0.00 | Details |
| 2 | Heparin Sodium | Brand | Tier 1 | $0.00 | Details |
| 3 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 4 | Potassium Chloride | Brand | Tier 1 | $0.00 | Details |
| 5 | Ampicillin and Sulbactam | Brand | Tier 1 | $0.00 | Details |
| 6 | amiloride hydrochloride | Brand | Tier 1 | $0.00 | Details |
| 7 | PIFELTRO doravirine | Brand | Tier 1 | $0.00 | Details |
| 8 | WELIREG belzutifan | Brand | Tier 1 | $0.00 | Details |
| 9 | Metoclopramide | Brand | Tier 1 | $0.00 | Details |
| 10 | Teflaro ceftaroline fosamil | Brand | Tier 1 | $0.00 | Details |
| 11 | BOSULIF Bosutinib | Brand | Tier 1 | $0.00 | Details |
| 12 | Ciprofloxacin | Brand | Tier 1 | $0.00 | Details |
| 13 | ISENTRESS RALTEGRAVIR | Brand | Tier 1 | $0.00 | Details |
| 14 | Leucovorin Calcium | Brand | Tier 1 | $0.00 | Details |
| 15 | Nitroglycerin nitroglycerin | Brand | Tier 1 | $0.00 | Details |
| 16 | VALPROIC ACID | Brand | Tier 1 | $0.00 | Details |
| 17 | Dicyclomine Dicyclomine hydrochloride | Brand | Tier 1 | $0.00 | Details |
| 18 | Cilostazol | Brand | Tier 1 | $0.00 | Details |
| 19 | Fluphenazine Hydrochloride | Brand | Tier 1 | $0.00 | Details |
| 20 | Nefazodone Hydrochloride | Brand | Tier 1 | $0.00 | Details |
Showing 20 of 979 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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