2010 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Network PlatinumPremier Pharmacy (PPO) | ||||
Location: | Brown, Wisconsin Click to see other locations | ||||
Plan ID: | H5215 - 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 Network PlatinumPremier Pharmacy (PPO) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $115.00 | ||||
Annual Deductible: | $0 | ||||
Annual Initial Coverage Limit (ICL): | $2,500 | ||||
Health Plan Type: | Local PPO | ||||
Gap Coverage? | Many Generics | ||||
Total Number of Formulary Drugs: | 4,911 drugs | Browse the Network PlatinumPremier Pharmacy (PPO) Formulary | |||
This plan has 5 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: | $7.00 | $7.00 | $26.00 | $53.00 | 25% |
• Number of Drugs per Tier: | 151 | 1789 | 703 | 1916 | 352 |
Number of Members enrolled in this plan in (H5215 - 005): | 6,491 members |