Medicare Advantage Plan Benefit Details in Plain Text |
The following Medicare Advantage plan benefits apply to the MCS Classicare InteliCare (HMO) (H5577 - 005) in Orocovis, Puerto Rico . This plan is administered by MCS ADVANTAGE, INC.. To switch to a different Medicare Advantage plan or to change your location, click here. |
Click here to see the MCS Classicare InteliCare (HMO) health and prescription benefit details in chart format
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Plan Premium |
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 HMO plan. |
Plan Membership and Plan Ratings |
The MCS Classicare InteliCare (HMO) (H5577 - 005) currently has 10,281 members. There are 15 members enrolled in this plan in Orocovis, Puerto Rico. |
The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4 stars. The detail CMS plan carrier ratings are as follows:
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Prescription Drug Coverage: Deductible, Cost-sharing, Formulary |
This plan does NOT have a deductible for the prescription drug coverage. That means that you have first dollar coverage. Some plans have a deductible that must be paid (in full) prior to the prescription coverage assisting in your prescription costs (see cost-sharing below). The maximum deductible for 2017 is $400. This plan (MCS Classicare InteliCare (HMO)) has no deductible. |
The following information is about the MCS Classicare InteliCare (HMO) formulary (or drug list). There are 3020 drugs on the MCS Classicare InteliCare (HMO) formulary. Click here to browse the MCS Classicare InteliCare (HMO) Formulary. |
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. Since this plan has no deductible, your coverage (initial coverage phase) will start right away. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The MCS Classicare InteliCare (HMO)’s formulary is divided into 6 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:
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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 49% 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 10% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 60% 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 (MCS Classicare InteliCare (HMO)) offers Coverage in the gap, however Medicare has not specified the details of the gap coverage. |
The MCS Classicare InteliCare (HMO) offers many Health and Prescription Drug Coverage Benefits. The following section will describe these benefits in detail. |