2021
2022

Walmart Value Rx Plan – S5601-205

Premium: $17.20

Deductible: $445 (Tiers 3-5)

Summary of Benefits

Evidence of Coverage

Comprehensive Formulary

Basic Rx Plan – S5601-060

Premium: $34.00

Deductible: $445 (All Tiers)

Summary of Benefits

Evidence of Coverage

Comprehensive Formulary

Premier Rx Plan – S5601-061

Premium: $65.30

Deductible: $445 (Tiers 3-5)

Summary of Benefits

Evidence of Coverage

Comprehensive Formulary

Walmart Value Rx Plan – S5884-209

Premium: $22.70

Deductible: $480 (Tiers 3-5)

Summary of Benefits

Evidence of Coverage

Basic Rx Plan – S5884-113

Premium: $38.20

Deductible: $480 (All Tiers)

Summary of Benefits

Evidence of Coverage

Premier Rx Plan – S5884-176

Premium: $75.30

Deductible: $480 (Tiers 3-5)

Summary of Benefits

Evidence of Coverage

Official Medicare Resources