2011 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Windsor Medicare Extra Gold Plan (HMO) | ||||
Location: | Cross, Arkansas Click to see other locations | ||||
Plan ID: | H5698 - 020 - 0 Click to see other plans | ||||
Member Services: | 1-800-316-2273 TTY users 1-866-460-7617 | ||||
— 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 Windsor Medicare Extra Gold Plan (HMO) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $35.00 (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): | $3,400 | ||||
Additional Gap Coverage? | Some Generics | ||||
Total Number of Formulary Drugs: | 2,525 drugs | Browse the Windsor Medicare Extra Gold Plan (HMO) 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: | $3.00 | $10.00 | $40.00 | $65.00 | 33% |
• Number of Drugs per Tier: | 203 | 1174 | 331 | 591 | 226 |
Plan's Pharmacy Search: | http://www.windsorextra.com | ||||
Number of Members enrolled in this plan in (H5698 - 020): | 2,682 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 — |