2020 Medicare Advantage Plan Prescription Drug Cost-Sharing Details

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2020 Medicare Part D Prescription Drug
Formulary (Drug List) Cost-Sharing Details
CareFree PLUS (HMO) (H1019-076-0)
Benefits & Contact Info        
This plan is available in Miami-Dade County, FL

Monthly Premium: $0.00
Rx Deductible: $0
Initial Coverage Limit: $4,020


Click on a letter below to view the
CareFree PLUS (HMO) Formulary
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This Plan Uses Lower Cost-Sharing for Preferred Pharmacies
  30-Day Supply
Cost-Sharing
90-Day Supply
Cost-Sharing
Preferred Pharmacy Standard Pharmacy Mail- Order* Preferred Pharmacy Standard Pharmacy Mail- Order*
This plan does not have an Initial Deductible:n/an/an/an/an/an/a
Initial Coverage Phase Cost-Sharing
Tier 1: : $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Tier 2: : $0.00 $10.00 $0.00 $0.00 $30.00 $0.00
Tier 3: : $47.00 $47.00 $47.00 $141.00 $141.00 $131.00
Tier 4: : $97.00 $100.00 $97.00 $291.00 $300.00 $281.00
Tier 5: : 33% 33% 33% n/a n/a n/a
Coverage Gap (Donut Hole) Phase Cost Sharing
Plan offers no Gap Coverage 75% Generic and 75% Brand Donut Hole Discount applies
All Formulary Generic Drugs: 25% 25% 25% 25% 25% 25%
All Formulary Brand-Name Drugs: 25% 25% 25% 25% 25% 25%
Catastrophic Coverage Phase Cost Sharing
Generic & Preferred Multi-Source Drugs: The greater of 5% or $3.60 The greater of 5% or $3.60
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): The greater of 5% or $8.95 The greater of 5% or $8.95
Go to the CareFree PLUS (HMO) 2020 Formulary Browser by choosing a letter below:
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