2011 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | UPMC for Life (PDP) by UPMC Health Plan | ||||
State: | West Virginia | ||||
Plan ID: | S3389 - 005 - 0 Click to see other plans | ||||
Member Services: | 1-877-539-3080 TTY users 1-800-361-2629 | ||||
— 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 UPMC for Life (PDP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $84.90 | ||||
Annual Deductible: | $0 | ||||
$0 Premium if Full LIS Benefits? | No, this plan does NOT qualify for the $0 Premium. | ||||
Annual Initial Coverage Limit (ICL): | $2,840 | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,193 drugs | Browse the UPMC for Life (PDP) 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 | $38.00 | $86.00 | 33% | |
• Number of Drugs per Tier: | 1864 | 434 | 541 | 354 | |
Plan Type (Reach): | Regional Plan | ||||
Number of Members enrolled in this plan in your CMS Region: | 422 members (CMS Region 06) | ||||
Number of Members enrolled in this plan nationally: | 440 members |