|Medicare Advantage Plan Benefit Details in Plain Text|
|The following Medicare Advantage plan benefits apply to the Today's Options Advantage 650B powered by CCRx (PPO) (H5378 - 190) in Greene, Missouri . |
This plan is administered by THE PYRAMID LIFE INSURANCE COMPANY. To switch to a different Medicare Advantage plan or to change your location, click here.
Click here to see the Today's Options Advantage 650B powered by CCRx (PPO) health and prescription benefit details in chart format
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|This plan has a $0.00 monthly premium. Although you pay no additional monthly premium, you must continue to pay your Medicare Part B premium. If you have a premium penalty, your premium will be higher. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA).|
|This Medicare Advantage Plan with Prescription Drug Coverage is a Local PPO plan.|
|Prescription Drug Coverage: Deductible, Cost-sharing, Formulary|
|This plan has a $150 deductible. So, you are 100% responsible for the first $150 in medication costs. After you have met the deductible, the Today's Options Advantage 650B powered by CCRx (PPO) will share the costs of your medications with you (see cost-sharing below). The maximum deductible for 2011 is $310, but this plan (Today's Options Advantage 650B powered by CCRx (PPO)) has a $150. There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. Click here to review plans with a $0 deductible.|
|The Initial Coverage Phase (ICP) can be thought of as the cost-sharing phase of the plan. During this phase, you and the insurance company share your prescription costs. Once you have spent $150, your initial coverage phase will start. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The Today's Options Advantage 650B powered by CCRx (PPO)’s formulary is divided into 4 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan is divided as follows: |
|The Coverage Gap, which is also known as the Donut (Doughnut) Hole is the phase of your Medicare Part D plan where
you are responsible for 100% of your medication costs. Healthcare Reform mandates that the insurance carrier pay 7% of your generic drug prescription costs in the donut hole on your behalf. |
The brand-name drug manufacturer will pay 50% and your plan will pay an additional 0% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 50% discount. The 50% paid by the brand-name drug manufacturer is paid on your behalf and therefore counts toward your TrOOP (or True Out-of-Pocket) costs. The portion paid by your plan, does not count toward TrOOP. Some Medicare Part D plans offer coverage during the Coverage Gap that is beyond the mandated discounts. Any drug not covered by the plan’s Gap Coverage will still receive the discounts noted above -- even if the plan has "No Gap Coverage". This plan (Today's Options Advantage 650B powered by CCRx (PPO)) offers No Coverage during the Coverage Gap phase.
|The Today's Options Advantage 650B powered by CCRx (PPO) offers many Health and Prescription Drug Coverage Benefits. The following section will describe these benefits in detail.|