2010 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | GHI Medicare PPO II (PPO) | ||||
Location: | Orange, New York Click to see other locations | ||||
Plan ID: | H5528 - 005 - 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 GHI Medicare PPO II (PPO) benefit details
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— Medicare Plan Features — | |||||
Monthly Premium: | $29.00 | ||||
Annual Deductible: | $0 | ||||
Annual Initial Coverage Limit (ICL): | $2,520 | ||||
Health Plan Type: | Local PPO | ||||
Gap Coverage? | No Gap Coverage | ||||
Total Number of Formulary Drugs: | 4,852 drugs | Browse the GHI Medicare PPO II (PPO) Formulary | |||
This plan has 4 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: | $5.00 | $20.00 | 50% | 33% | |
• Number of Drugs per Tier: | 1565 | 682 | 2502 | 103 | |
Number of Members enrolled in this plan in (H5528 - 005): | 4,096 members |