2022 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Vantage PREMIUM (HMO-POS) | ||||
Location: | St. Landry, Louisiana Click to see other locations | ||||
Plan ID: | H5576 - 018 - 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 Vantage PREMIUM (HMO-POS) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $171.00 | ||||
Annual Rx Deductible: | $0 | ||||
Annual Rx Initial Coverage Limit (ICL): | $4,430 | ||||
Health Plan Type: | Local HMO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $3,500 | ||||
Additional Rx Gap Coverage? | Yes, some additional gap coverage. | ||||
Total Number of Formulary Drugs: | 3,947 drugs | Browse the Vantage PREMIUM (HMO-POS) Formulary | |||
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers. | |||||
This plan offers select insulin at a $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 | $14.00 | $47.00 | $100.00 | 33% |
• Number of Drugs per Tier: | 533 | 1947 | 479 | 365 | 623 |
Plan Offers Mail Order? | Yes | ||||
Medicare Plan Pharmacy Numbers: | BIN: 610602 PCN: NVTD See BIN/PCNs for all plans | ||||
Number of Members enrolled in this plan in St. Landry, Louisiana: | less than 10 members | ||||
Number of Members enrolled in this plan in Louisiana: | 599 members | ||||
Number of Members enrolled in this plan in (H5576 - 018): | 725 members | ||||
Plan’s Summary Star Rating: | 4.5 out of 5 Stars. | ||||
• Customer Service Rating: | 3 out of 5 Stars. | ||||
• Member Experience Rating: | 5 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 5 out of 5 Stars. |
— Plan Health Benefits — |