2009 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | PICA-001 by Pharmacy Insurance Corporation of America - PICA | ||||
State: | Puerto Rico | ||||
Plan ID: | S5775 - 001 - 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 PICA-001 benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $38.00 | ||||
Annual Deductible: | $0 | ||||
$0 Premium if Full LIS Benefits? | No, this plan does NOT qualify for the $0 Premium. | ||||
Gap Coverage? | No Gap Coverage | ||||
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: | $3.00 | $25.00 | $50.00 | 25% | |
Plan Offers Mail Order? | Yes | ||||
Plan Type (Reach): | Regional Plan | ||||
Number of Members enrolled in this plan in Puerto Rico: | 11,484 members (CMS Region 38) | ||||
Number of Members enrolled in this plan nationally: | 11,484 members |