2014 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | CCHP Senior Program (HMO) | ||||
Location: | San Mateo, California Click to see other locations | ||||
Plan ID: | H0571 - 001 - 0 Click to see other plans | ||||
Member Services: | 1-888-775-7888 TTY users 1-877-681-8898 | ||||
— This plan information is for research purposes only. — Click here to see plans for the current plan year | |||||
— This plan was sanctioned in 2014 — | |||||
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 CCHP Senior Program (HMO) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $40.00 (see Plan Premium Details below) | ||||
Annual Deductible: | $310 | ||||
Annual Initial Coverage Limit (ICL): | $2,850 | ||||
Health Plan Type: | Local HMO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $3,400 | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 5,103 drugs | Browse the CCHP Senior Program (HMO) Formulary | |||
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $3.00 | $7.00 | $40.00 | $60.00 | 20% |
• Number of Drugs per Tier: | 95 | 2124 | 751 | 1819 | 314 |
Plan's Pharmacy Search: | http://www.cchphmo.com/drugbenefit.html | ||||
Plan Offers Mail Order? | Yes | ||||
Number of Members enrolled in this plan in (H0571 - 001): | 4,298 members | ||||
Plan’s Summary Star Rating: | 4 out of 5 Stars. | ||||
• Customer Service Rating: | 3 out of 5 Stars. | ||||
• Member Experience Rating: | 2 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 5 out of 5 Stars. | ||||
— 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 — |