2019 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Medicare HMO Blue ValueRx (HMO) | ||||
Location: | Worcester, Massachusetts Click to see other locations | ||||
Plan ID: | H2261 - 022 - 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 Medicare HMO Blue ValueRx (HMO) benefit details
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— Medicare Plan Features — | |||||
Monthly Premium: | $56.00 | ||||
Annual Deductible: | $320 | ||||
Annual Initial Coverage Limit (ICL): | $3,820 | ||||
Health Plan Type: | Local HMO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $4,900 | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,873 drugs | Browse the Medicare HMO Blue ValueRx (HMO) Formulary | |||
This plan has 5 drug tiers.
See cost-sharing for all pharmacies and tiers.
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Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $3.00 | $7.00 | $42.00 | $95.00 | 26% |
• Number of Drugs per Tier: | 670 | 1973 | 296 | 179 | 755 |
Plan Offers Mail Order? | Yes | ||||
Number of Members enrolled in this plan in Worcester, Massachusetts: | 719 members | ||||
Number of Members enrolled in this plan in Massachusetts: | 5,200 members | ||||
Number of Members enrolled in this plan in (H2261 - 022): | 5,202 members | ||||
Plan’s Summary Star Rating: | 4.5 out of 5 Stars. | ||||
• Customer Service Rating: | 5 out of 5 Stars. | ||||
• Member Experience Rating: | 4 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 5 out of 5 Stars. |
— Plan Health Benefits — |