2024 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Wellpoint Dual Advantage (HMO D-SNP) | ||||
Location: | Archer, Texas Click to see other locations | ||||
Plan ID: | H8849 - 011 - 6 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 Wellpoint Dual Advantage (HMO D-SNP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $0.00 for people who qualify for both Medicare and Medicaid. | ||||
Annual Rx Deductible: | $0 for people who qualify for both Medicare and Medicaid. | ||||
Annual Rx Initial Coverage Limit (ICL): | $5,030 | ||||
Health Plan Type: | Local HMO | ||||
Special Needs Plan (SNP) Eligibility Requirement: | Dual-Eligible | ||||
Additional Rx Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,627 drugs | Browse the Wellpoint Dual Advantage (HMO D-SNP) Formulary | |||
This plan has 6 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: | 15% | 15% | 15% | 15% | 15% |
• Number of Drugs per Tier: | 223 | 549 | 841 | 1039 | 699 |
Plan Offers Mail Order? | Yes | ||||
Medicare Plan Pharmacy Numbers: | BIN: 020115 PCN: IS See BIN/PCNs for all plans | ||||
Number of Members enrolled in this plan in Archer, Texas: | less than 10 members | ||||
Number of Members enrolled in this plan in (H8849 - 011): | 2,321 members | ||||
Plan’s Summary Star Rating: | 3 out of 5 Stars. | ||||
• Customer Service Rating: | 4 out of 5 Stars. | ||||
• Member Experience Rating: | 2 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 3 out of 5 Stars. |
— Plan Health Benefits — |