2024 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Presbyterian Dual Plus (HMO D-SNP) | ||||
Location: | Socorro, New Mexico Click to see other locations | ||||
Plan ID: | H3204 - 013 - 0 Click to see other plans | ||||
Member Services: | |||||
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 Presbyterian Dual Plus (HMO D-SNP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $0.00 for people who qualify for both Medicare and Medicaid. | ||||
Annual Deductible: | $0 for people who qualify for both Medicare and Medicaid. | ||||
Annual Initial Coverage Limit (ICL): | $5,030 | ||||
Health Plan Type: | Local HMO | ||||
Special Needs Plan (SNP) Eligibility Requirement: | Dual-Eligible | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,185 drugs | Browse the Presbyterian Dual Plus (HMO D-SNP) Formulary | |||
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers. | |||||
Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $0.00 | $20.00 | 18% | 48% | 25% |
• Number of Drugs per Tier: | 196 | 1123 | 575 | 603 | 688 |
Plan Offers Mail Order? | Yes | ||||
Medicare Plan Pharmacy Numbers: | BIN: 610593 PCN: PHPMEDD See BIN/PCNs for all plans | ||||
Number of Members enrolled in this plan in New Mexico: | 6,745 members | ||||
Number of Members enrolled in this plan in (H3204 - 013): | 16,964 members | ||||
Plan’s Summary Star Rating: | 3 out of 5 Stars. | ||||
• Customer Service Rating: | 3 out of 5 Stars. | ||||
• Member Experience Rating: | 2 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 3 out of 5 Stars. |
— Plan Health Benefits — |