2018 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Vibra Health Plan Enhanced Coverage (PPO) | ||||
Location: | Carbon, Pennsylvania Click to see other locations | ||||
Plan ID: | H9408 - 002 - 0 Click to see other plans | ||||
Member Services: | 1-844-388-8268 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 Vibra Health Plan Enhanced Coverage (PPO) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $55.00 (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): | $4,800 | ||||
Additional Gap Coverage? | Yes, some additional gap coverage. | ||||
Total Number of Formulary Drugs: | 3,474 drugs | Browse the Vibra Health Plan Enhanced Coverage (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: | $0.00 | $10.00 | $35.00 | $90.00 | 33% |
• Number of Drugs per Tier: | 239 | 1279 | 458 | 591 | 736 |
Plan's Pharmacy Search: | http://www.vibrahealthplan.com | ||||
Plan Offers Mail Order? | No | ||||
Number of Members enrolled in this plan in Pennsylvania: | 193 members | ||||
Number of Members enrolled in this plan in (H9408 - 002): | 493 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 Base Premium | Part D Supplemental Premium | |
$55.00 | $15.10 | $39.90 | $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: | $2.70 | $12.00 | $21.30 | $30.60 | |
Total Monthly Premium with LIS (Parts C & D): | $17.80 | $27.10 | $36.40 | $45.70 |
— Plan Health Benefits — |