Medicare Advantage Plan Benefit Details in Plain Text | |||||||||||||||||||||||||||
The following Medicare Advantage plan benefits apply to the Regence MedAdvantage + Rx Classic (PPO) (H5009 - 002) in Thurston, Washington State . This plan is administered by REGENCE BLUESHIELD. To switch to a different Medicare Advantage plan or to change your location, click here. | |||||||||||||||||||||||||||
Click here to see the Regence MedAdvantage + Rx Classic (PPO) health and prescription benefit details in chart format
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Plan Premium | |||||||||||||||||||||||||||
The Regence MedAdvantage + Rx Classic (PPO) has a monthly premium of $172.00. That is $2,064.00 for 12 months. There are a few factors that can increase or decrease this premium.
If you qualify for full or partial extra help, your premium will be lower. If you have a premium penalty, your premium will be higher.
Please remember that the $172.00 montly premium is in addition to 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. | |||||||||||||||||||||||||||
Plan Membership and Plan Ratings | |||||||||||||||||||||||||||
The Regence MedAdvantage + Rx Classic (PPO) (H5009 - 002) currently has 18,443 members. There are 693 members enrolled in this plan in Thurston, Washington State. | |||||||||||||||||||||||||||
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 has a $215 deductible. However, formulary drugs on Tier 6 are excluded from the $215 deductible and have first dollar coverage (or a $0 deductible). So, you are 100% responsible for the first $215 in medication costs for drugs not on the excluded tiers. After you have met the deductible, the Regence MedAdvantage + Rx Classic (PPO) will share the costs of your medications with you (see cost-sharing below). The maximum deductible for 2017 is $400, but this plan (Regence MedAdvantage + Rx Classic (PPO)) has a $215. 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 following information is about the Regence MedAdvantage + Rx Classic (PPO) formulary (or drug list). There are 3669 drugs on the Regence MedAdvantage + Rx Classic (PPO) formulary. Click here to browse the Regence MedAdvantage + Rx Classic (PPO) 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. Once you have spent $215, 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 Regence MedAdvantage + Rx Classic (PPO)’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 (Regence MedAdvantage + Rx Classic (PPO)) offers No Coverage during the Coverage Gap phase. | |||||||||||||||||||||||||||
The Regence MedAdvantage + Rx Classic (PPO) offers many Health and Prescription Drug Coverage Benefits. The following section will describe these benefits in detail. | |||||||||||||||||||||||||||
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