2020 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Blue Medicare Essential Plus (HMO) | ||||
Location: | Stokes, North Carolina Click to see other locations | ||||
Plan ID: | H3449 - 023 - 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 Blue Medicare Essential Plus (HMO) benefit details
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— Medicare Plan Features — | |||||
Monthly Premium: | $19.00 | ||||
Annual Deductible: | $195 | ||||
Annual Initial Coverage Limit (ICL): | $4,020 | ||||
Health Plan Type: | Local HMO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $6,700 | ||||
Additional Gap Coverage? | Yes, some additional gap coverage. | ||||
Total Number of Formulary Drugs: | 2,963 drugs | Browse the Blue Medicare Essential Plus (HMO) Formulary | |||
This plan has 6 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: | $0.00 | $10.00 | $37.00 | 45% | 25% |
• Number of Drugs per Tier: | 23 | 581 | 837 | 677 | 664 |
Plan Offers Mail Order? | Yes | ||||
Medicare Plan Pharmacy Numbers: | BIN: 015905 PCN: HMONC See BIN/PCNs for all plans | ||||
Number of Members enrolled in this plan in Stokes, North Carolina: | 59 members | ||||
Number of Members enrolled in this plan in North Carolina: | 26,247 members | ||||
Number of Members enrolled in this plan in (H3449 - 023): | 25,940 members | ||||
Plan’s Summary Star Rating: | 3.5 out of 5 Stars. | ||||
• Customer Service Rating: | 5 out of 5 Stars. | ||||
• Member Experience Rating: | 3 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 4 out of 5 Stars. |
— Plan Health Benefits — |