2018 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Virginia Premier Advantage Platinum (HMO) | ||||
Location: | Nottoway, Virginia Click to see other locations | ||||
Plan ID: | H9877 - 003 - 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 Virginia Premier Advantage Platinum (HMO) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $29.00 (see Plan Premium Details below) | ||||
Annual Rx Deductible: | $100 (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): | $5,900 | ||||
Additional Rx Gap Coverage? | Yes, some additional gap coverage. | ||||
Total Number of Formulary Drugs: | 3,673 drugs | Browse the Virginia Premier Advantage Platinum (HMO) 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: | $0.00 | $12.00 | $47.00 | $100.00 | 31% |
• Number of Drugs per Tier: | 871 | 1031 | 535 | 564 | 672 |
Plan Offers Mail Order? | No | ||||
Number of Members enrolled in this plan in Virginia: | 185 members | ||||
Number of Members enrolled in this plan in (H9877 - 003): | 459 members | ||||
Plan’s Summary Star Rating: | New plan - No summary rating as of yet. | ||||
• Customer Service Rating: | New plan - not yet rated. | ||||
• Member Experience Rating: | New plan - not yet rated. | ||||
• Drug Cost Accuracy Rating: | New plan - not yet rated. | ||||
— Plan Premium Details — | |||||
The Monthly Premium is Split as Follows: ❔ | Total Premium | Part C Premium | Part D Basic Premium | Part D Supplemental Premium | |
$29.00 | $0.00 | $29.00 | $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: | $0.00 | $7.20 | $14.50 | $21.70 | |
Total Monthly Premium with LIS (Parts C & D): | $0.00 | $7.20 | $14.50 | $21.70 |
— Plan Health Benefits — |