2016 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Geisinger Gold Classic Complete Rx (HMO) | ||||
Location: | Potter, Pennsylvania Click to see other locations | ||||
Plan ID: | H3954 - 158 - 0 Click to see other plans | ||||
Member Services: | |||||
— 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 Geisinger Gold Classic Complete Rx (HMO) benefit details
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— Medicare Plan Features — | |||||
Monthly Premium: | $0.00 | ||||
Annual Rx Deductible: | $0 | ||||
Annual Rx Initial Coverage Limit (ICL): | $3,310 | ||||
Health Plan Type: | Local HMO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $5,900 | ||||
Additional Rx Gap Coverage? | Yes, some additional gap coverage. | ||||
Total Number of Formulary Drugs: | 3,823 drugs | Browse the Geisinger Gold Classic Complete Rx (HMO) Formulary | |||
This plan has 5 drug tiers.
See cost-sharing for all pharmacies and tiers.
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Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $3.00 | $20.00 | $47.00 | $100.00 | 33% |
• Number of Drugs per Tier: | 157 | 2310 | 308 | 505 | 543 |
Plan Offers Mail Order? | Yes | ||||
Number of Members enrolled in this plan in Potter, Pennsylvania: | 50 members | ||||
Number of Members enrolled in this plan in Pennsylvania: | 19,613 members | ||||
Number of Members enrolled in this plan in (H3954 - 158): | 19,637 members | ||||
Plan’s Summary Star Rating: | 4.5 out of 5 Stars. | ||||
• Customer Service Rating: | 4 out of 5 Stars. | ||||
• Member Experience Rating: | 5 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 4 out of 5 Stars. | ||||
— Plan Health Benefits — |