2010 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Senior Advantage Medicare Medicaid Plan (HMO) | ||||
Location: | Boulder, Colorado Click to see other locations | ||||
Plan ID: | H0630 - 014 - 0 Click to see other plans | ||||
Member Services: | |||||
— This plan information is for research purposes only. — Click here to see plans for the current plan year | |||||
Medicare Contact Information: | Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. TTY users 1-877-486-2048 or contact your local SHIP for assistance |
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Email a copy of the Senior Advantage Medicare Medicaid Plan (HMO) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $0.00 for people who qualify for both Medicare and Medicaid. | ||||
Annual Rx Deductible: | $0 for people who qualify for both Medicare and Medicaid. | ||||
Annual Rx Initial Coverage Limit (ICL): | $2,830 | ||||
Health Plan Type: | Local HMO | ||||
Special Needs Plan (SNP) Eligibility Requirement: | Dual-Eligible | ||||
Rx Gap Coverage? | No Gap Coverage | ||||
Total Number of Formulary Drugs: | 2,302 drugs | Browse the Senior Advantage Medicare Medicaid Plan (HMO) Formulary | |||
This plan has 3 drug tiers. See cost-sharing highlights below. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | 25% | 25% | 25% | ||
• Number of Drugs per Tier: | 1339 | 810 | 153 | ||
Number of Members enrolled in this plan in (H0630 - 014): | 2,496 members |