2017 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Medicare Plus Blue PPO Signature (PPO) | ||||
Location: | Alcona, Michigan Click to see other locations | ||||
Plan ID: | H9572 - 001 - 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 Medicare Plus Blue PPO Signature (PPO) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $181.00 | ||||
Annual Rx Deductible: | $105 | ||||
Annual Rx Initial Coverage Limit (ICL): | $3,700 | ||||
Health Plan Type: | Local PPO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $4,700 | ||||
Additional Rx Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,973 drugs | Browse the Medicare Plus Blue PPO Signature (PPO) 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 | $15.00 | $45.00 | 45% | 30% |
• Number of Drugs per Tier: | 487 | 1634 | 374 | 859 | 619 |
Plan Offers Mail Order? | Yes | ||||
Number of Members enrolled in this plan in (H9572 - 001): | 40,403 members | ||||
Plan’s Summary Star Rating: | 4 out of 5 Stars. | ||||
• Customer Service Rating: | 5 out of 5 Stars. | ||||
• Member Experience Rating: | 3 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 4 out of 5 Stars. | ||||
— Plan Health Benefits — |