2011 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Geisinger Gold Classic 3 $0 Deductible Rx (HMO) | ||||
Location: | Luzerne, Pennsylvania Click to see other locations | ||||
Plan ID: | H3954 - 100 - 0 Click to see other plans | ||||
Member Services: | 1-800-498-9731 TTY users 711 | ||||
— 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 Geisinger Gold Classic 3 $0 Deductible Rx (HMO) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $36.00 (see Plan Premium Details below) | ||||
Annual Rx Deductible: | $0 | ||||
Annual Rx Initial Coverage Limit (ICL): | $2,840 | ||||
Health Plan Type: | Local HMO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $2,200 | ||||
Additional Rx Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 2,120 drugs | Browse the Geisinger Gold Classic 3 $0 Deductible Rx (HMO) 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: | $6.00 | $39.00 | $69.00 | 33% | |
• Number of Drugs per Tier: | 1269 | 471 | 269 | 111 | |
Plan's Pharmacy Search: | http://www.geisingergold.com | ||||
Number of Members enrolled in this plan in (H3954 - 100): | 1,971 members | ||||
— Plan Premium Details — | |||||
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ | 100% Subsidy | 75% Subsidy | 50% Subsidy | 25% Subsidy | |
Monthly Part D Premium with LIS: | $0.00 | $0.00 | $0.00 | $0.00 | |
— Plan Health Benefits — |