2018 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | FirstMedicare Direct PPO Plus (PPO) | ||||
Location: | Moore, North Carolina Click to see other locations | ||||
Plan ID: | H8064 - 002 - 0 Click to see other plans | ||||
Member Services: | 1-844-201-4957 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 FirstMedicare Direct PPO Plus (PPO) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $73.00 (see Plan Premium Details below) | ||||
Annual Deductible: | $0 | ||||
Annual Initial Coverage Limit (ICL): | $3,750 | ||||
Health Plan Type: | Local PPO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $5,000 | ||||
Additional Gap Coverage? | Yes, some additional gap coverage. | ||||
Total Number of Formulary Drugs: | 3,974 drugs | Browse the FirstMedicare Direct PPO Plus (PPO) Formulary | |||
This plan has 6 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: | $8.00 | $20.00 | $45.00 | $100.00 | 33% |
• Number of Drugs per Tier: | 220 | 1560 | 451 | 807 | 789 |
Plan's Pharmacy Search: | http://www.firstmedicare.com | ||||
Plan Offers Mail Order? | No | ||||
Number of Members enrolled in this plan in Moore, North Carolina: | 504 members | ||||
Number of Members enrolled in this plan in North Carolina: | 632 members | ||||
Number of Members enrolled in this plan in (H8064 - 002): | 887 members | ||||
Plan’s Summary Star Rating: | 3.5 out of 5 Stars. | ||||
• Customer Service Rating: | 4 out of 5 Stars. | ||||
• Member Experience Rating: | 4 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 3 out of 5 Stars. | ||||
— Plan Premium Details — | |||||
The Monthly Premium is Split as Follows: ❔ | Total Premium | Part C Premium | Part D Base Premium | Part D Supplemental Premium | |
$73.00 | $28.80 | $44.20 | $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: | $14.00 | $21.60 | $29.10 | $36.70 | |
Total Monthly Premium with LIS (Parts C & D): | $42.80 | $50.40 | $57.90 | $65.50 |
— Plan Health Benefits — |