2021 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Community Blue Medicare HMO Signature (HMO) | ||||
Location: | Allegheny, Pennsylvania Click to see other locations | ||||
Plan ID: | H3957 - 047 - 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 Community Blue Medicare HMO Signature (HMO) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $0.00 | ||||
Medicare Part B Premium Reduction: | This plan has a $2 Part B monthly premium rebate (or giveback). However, you must continue to pay your Medicare Part B premium. | ||||
Annual Deductible: | $0 | ||||
Annual Initial Coverage Limit (ICL): | $4,130 | ||||
Health Plan Type: | Local HMO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $7,550 | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,662 drugs | Browse the Community Blue Medicare HMO Signature (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: | $0.00 | $5.00 | $47.00 | $100.00 | 33% |
• Number of Drugs per Tier: | 319 | 1121 | 637 | 712 | 873 |
Plan Offers Mail Order? | Yes | ||||
Number of Members enrolled in this plan in Allegheny, Pennsylvania: | 9,549 members | ||||
Number of Members enrolled in this plan in Pennsylvania: | 27,789 members | ||||
Number of Members enrolled in this plan in (H3957 - 047): | 27,813 members | ||||
Plan’s Summary Star Rating: | 4 out of 5 Stars. | ||||
• Customer Service Rating: | 4 out of 5 Stars. | ||||
• Member Experience Rating: | 4 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 5 out of 5 Stars. |
— Plan Health Benefits — |