2011 Medicare Advantage Plan Details | |||||
---|---|---|---|---|---|
Medicare Plan Name: | Medicare Masterpiece Premier SNP - Dementia (HMO SNP) | ||||
Location: | Orange, Florida Click to see other locations | ||||
Plan ID: | H5404 - 136 - 0 Click to see other plans | ||||
Member Services: | 1-866-690-4842 TTY users 1-800-617-0177 | ||||
— 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 |
||||
Email a copy of the Medicare Masterpiece Premier SNP - Dementia (HMO SNP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $0.00 (see Plan Premium Details below) | ||||
Annual Deductible: | $0 | ||||
Annual Initial Coverage Limit (ICL): | $2,840 | ||||
Health Plan Type: | Local HMO | ||||
Special Needs Plan (SNP) Eligibility Requirement: | |||||
Additional Gap Coverage? | Many Generics | ||||
Total Number of Formulary Drugs: | 3,056 drugs | Browse the Medicare Masterpiece Premier SNP - Dementia (HMO SNP) 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: | 0% | 0% | $20.00 | $50.00 | 33% |
• Number of Drugs per Tier: | 578 | 1188 | 922 | 190 | 178 |
Plan's Pharmacy Search: | http://www.univhc.com | ||||
Number of Members enrolled in this plan in (H5404 - 136): | 118 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 — | |||||
** Cost ** | |||||
Premium and Other Important Information | |||||
This plan does not cover all Medicare-covered preventive services with zero cost sharing. | |||||
Universal Health Care Inc. will reduce your monthly Medicare Part B premium by up to $ 96.40. | |||||
** Important Information ** | |||||
This plan does not cover all Medicare-covered preventive services with zero cost sharing. | |||||
Universal Health Care Inc. will reduce your monthly Medicare Part B premium by up to $ 96.40. | |||||
** Preventive Services ** | |||||
Colorectal Screening Exams | |||||
$0 copay for Medicare-covered colorectal screenings. |