|Medicare Advantage Plan Benefit Details in Plain Text|
|The following Medicare Advantage plan benefits apply to the PriorityMedicare Merit (PPO) (H4875 - 016) in Leelanau, Michigan . |
This plan is administered by . To switch to a different Medicare Advantage plan or to change your location, click here.
Click here to see the PriorityMedicare Merit (PPO) health and prescription benefit details in chart format
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|The PriorityMedicare Merit (PPO) has a monthly premium of $97.00. That is $1,164.00 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 $97.00 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 PPO plan.|
|Plan Membership and Plan Ratings|
|The PriorityMedicare Merit (PPO) (H4875 - 016) currently has 19,163 members. There are 237 members enrolled in this plan in Leelanau, Michigan.|
|The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4 stars. The detail CMS plan carrier ratings are as follows:|
|Prescription Drug Coverage: Deductible, Cost-sharing, Formulary|
|This plan does NOT have a deductible for the prescription drug coverage. That means that you have first dollar coverage. Some plans have a deductible that must be paid (in full) prior to the prescription coverage assisting in your prescription costs (see cost-sharing below). The maximum deductible for 2020 is $435. This plan (PriorityMedicare Merit (PPO)) has no deductible.|
|The following information is about the PriorityMedicare Merit (PPO) formulary (or drug list). There are 3842 drugs on the PriorityMedicare Merit (PPO) formulary. Click here to browse the PriorityMedicare Merit (PPO) 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. Since this plan has no deductible, your coverage (initial coverage phase) will start right away. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The PriorityMedicare Merit (PPO)’s formulary is divided into 5 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: |
|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 75% of your generic drug prescription costs in the donut hole on your behalf. |
The brand-name drug manufacturer will pay 70% and your plan will pay an additional 5% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 75% discount. The 70% 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 (PriorityMedicare Merit (PPO)) offers No Coverage during the Coverage Gap phase.
|The PriorityMedicare Merit (PPO) offers many Health and Prescription Drug Coverage Benefits. The following section will describe these benefits in detail.|