Medicare Advantage Plan Benefit Details in Plain Text |
The following Medicare Advantage plan benefits apply to the MeridianCare Edge (HMO) (H5779 - 006) in Mercer, Illinois . This plan is administered by MERIDIAN HEALTH PLAN OF ILLINOIS, INC.. To switch to a different Medicare Advantage plan or to change your location, click here. |
Click here to see the MeridianCare Edge (HMO) health and prescription benefit details in chart format
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Plan Premium |
The MeridianCare Edge (HMO) has a monthly premium of $27.50. That is $330.00 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 $27.50 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 HMO plan. |
Plan Membership and Plan Ratings |
The MeridianCare Edge (HMO) (H5779 - 006) currently has 530 members. , and 148 members in Illinois. |
The Centers for Medicare and Medicaid Services (CMS) is not yet able to calculate a summary rating for this plan carrier. The detail CMS plan carrier ratings are as follows:
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Prescription Drug Coverage: Deductible, Cost-sharing, Formulary |
This plan has a $405 deductible. However, formulary drugs on Tier 6 are excluded from the $405 deductible and have first dollar coverage (or a $0 deductible). So, you are 100% responsible for the first $405 in medication costs for drugs not on the excluded tiers. After you have met the deductible, the MeridianCare Edge (HMO) will share the costs of your medications with you -- see cost-sharing below. $405 is the maximum deductible for 2018. 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 MeridianCare Edge (HMO) formulary (or drug list). There are 3881 drugs on the MeridianCare Edge (HMO) formulary. Click here to browse the MeridianCare Edge (HMO) 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 $405, 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 MeridianCare Edge (HMO)’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 56% 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 15% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 65% 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 (MeridianCare Edge (HMO)) offers No Coverage during the Coverage Gap phase. |
The MeridianCare Edge (HMO) offers many Health and Prescription Drug Coverage Benefits. The following section will describe these benefits in detail. |