2009 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | Community CCRx Gold by Universal American | ||||
State: | Wisconsin | ||||
Plan ID: | S5803 - 233 - 0 Click to see other plans | ||||
Member Services: | 1-866-684-5353 TTY users 1-866-684-5351 | ||||
— 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 CCRx Gold benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $62.30 | ||||
Annual Deductible: | $0 | ||||
$0 Premium if LIS Benefits? | No, this plan does NOT qualify for the $0 Premium. | ||||
Gap Coverage? | All Generics | ||||
Total Number of Formulary Drugs: | 3,287 drugs | Browse the Community CCRx Gold Formulary | |||
This plan has 4 drug tiers. See cost-sharing highlights below. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $5.00 | $30.00 | $60.00 | 33% | |
• Number of Drugs per Tier: | 1759 | 694 | 489 | 345 | |
Plan Offers Mail Order? | Yes | ||||
Plan Type (Reach): | National Plan | ||||
Number of Members enrolled in this plan in Wisconsin: | 495 members (CMS Region 16) | ||||
Number of Members enrolled in this plan nationally: | 68,325 members |