2022 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | CareFree (HMO) | ||||
Location: | Polk, Florida Click to see other locations | ||||
Plan ID: | H1019 - 104 - 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 CareFree (HMO) benefit details
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— Medicare Plan Features — | |||||
Monthly Premium: | $0.00 | ||||
Medicare Part B Premium Reduction: | This plan has a $148 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): | $4,430 | ||||
Health Plan Type: | Local HMO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $3,400 | ||||
Additional Gap Coverage? | Yes, some additional gap coverage. | ||||
Total Number of Formulary Drugs: | 3,491 drugs | Browse the CareFree (HMO) Formulary | |||
This plan has 5 drug tiers.
See cost-sharing for all pharmacies and tiers.
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This plan offers select insulin at a $20-$35 copay. Learn more. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $0.00 | $0.00 | $35.00 | $60.00 | 33% |
• Number of Drugs per Tier: | 397 | 650 | 856 | 899 | 689 |
Plan Offers Mail Order? | Yes | ||||
Medicare Plan Pharmacy Numbers: | BIN: 015581 PCN: 03200000 See BIN/PCNs for all plans | ||||
Number of Members enrolled in this plan in Polk, Florida: | 18,013 members | ||||
Number of Members enrolled in this plan in (H1019 - 104): | 33,509 members | ||||
Plan’s Summary Star Rating: | 5 out of 5 Stars. ![]() This plan qualifies for the 5-star rating Special Enrollment period. Read more. | ||||
• Customer Service Rating: | 5 out of 5 Stars. | ||||
• Member Experience Rating: | 5 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 5 out of 5 Stars. |
— Plan Health Benefits — |