2020 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Medicare HMO Blue ValueRx (HMO) | ||||
Location: | Franklin, 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 | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $36.00 | ||||
Annual Deductible: | $320 | ||||
Annual Initial Coverage Limit (ICL): | $4,020 | ||||
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: | 3,894 drugs | Browse the Medicare HMO Blue ValueRx (HMO) Formulary | |||
This plan has 5 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: | $2.00 | $6.00 | $42.00 | $95.00 | 26% |
• Number of Drugs per Tier: | 711 | 2016 | 253 | 143 | 771 |
Plan Offers Mail Order? | Yes | ||||
Medicare Plan Pharmacy Numbers: | BIN: 003858 PCN: MD See BIN/PCNs for all plans | ||||
Number of Members enrolled in this plan in Franklin, Massachusetts: | 275 members | ||||
Number of Members enrolled in this plan in Massachusetts: | 5,485 members | ||||
Number of Members enrolled in this plan in (H2261 - 022): | 5,435 members | ||||
Plan’s Summary Star Rating: | 4 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 — |