2018 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Providence Medicare Choice + RX (HMO-POS) | ||||
Location: | Yamhill, Oregon Click to see other locations | ||||
Plan ID: | H9047 - 024 - 0 Click to see other plans | ||||
Member Services: | 1-800-603-2340 TTY users 711 | ||||
— 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 Providence Medicare Choice + RX (HMO-POS) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $88.00 (see Plan Premium Details below) | ||||
Annual Rx Deductible: | $240 (Tier 1 and 2 excluded from the Deductible.) | ||||
Annual Rx Initial Coverage Limit (ICL): | $3,750 | ||||
Health Plan Type: | Local HMO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $3,400 | ||||
Additional Rx Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,623 drugs | Browse the Providence Medicare Choice + RX (HMO-POS) 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: | $7.00 | $18.00 | $47.00 | $100.00 | 28% |
• Number of Drugs per Tier: | 142 | 1686 | 288 | 894 | 613 |
Plan's Pharmacy Search: | http://providencehealthplan.com | ||||
Plan Offers Mail Order? | No | ||||
Number of Members enrolled in this plan in Yamhill, Oregon: | 1,591 members | ||||
Number of Members enrolled in this plan in (H9047 - 024): | 22,282 members | ||||
Plan’s Summary Star Rating: | 5 out of 5 Stars. This plan qualifies for the 5-star rating Special Enrollment period. Read more. | ||||
• Customer Service Rating: | 4 out of 5 Stars. | ||||
• Member Experience Rating: | 4 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 4 out of 5 Stars. | ||||
— Plan Premium Details — | |||||
The Monthly Premium is Split as Follows: ❔ | Total Premium | Part C Premium | Part D Basic Premium | Part D Supplemental Premium | |
$88.00 | $41.00 | $47.00 | $0.00 | ||
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ | 100% Subsidy | 75% Subsidy | 50% Subsidy | 25% Subsidy | |
Monthly Part D Premium with LIS: | $12.40 | $21.10 | $29.70 | $38.40 | |
Total Monthly Premium with LIS (Parts C & D): | $53.40 | $62.10 | $70.70 | $79.40 |
— Plan Health Benefits — |