2011 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Anthem Senior Advantage Plus (HMO) | ||||
Location: | Fairfield, Ohio Click to see other locations | ||||
Plan ID: | H3655 - 030 - 0 Click to see other plans | ||||
Member Services: | 1-800-467-1199 TTY users 1-888-853-7754 | ||||
— 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 Anthem Senior Advantage Plus (HMO) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $29.00 (see Plan Premium Details below) | ||||
Annual Deductible: | $0 | ||||
Annual Initial Coverage Limit (ICL): | $2,840 | ||||
Health Plan Type: | Local HMO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $3,000 | ||||
Additional Gap Coverage? | Many Generics | ||||
Total Number of Formulary Drugs: | 4,499 drugs | Browse the Anthem Senior Advantage Plus (HMO) Formulary | |||
This plan has 6 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 | $43.00 | $85.00 | 33% | 33% |
• Number of Drugs per Tier: | 1617 | 563 | 1426 | 554 | 339 |
Plan's Pharmacy Search: | http://www.anthem.com | ||||
Number of Members enrolled in this plan in (H3655 - 030): | 13,867 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 — |