St. Luke's Advantage Rx 01 (HMO)
Available to residents of Elmore County, ID for 2027. Contract H3012, plan 001, segment 0.
2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.
New for 2027. This plan has no 2026 predecessor in the CMS crosswalk.
Plan details
| Monthly premium (Part C + D) | $77.00 |
|---|---|
| — medical (Part C) part | $17.00 |
| — drug (Part D) part | $60.00 |
| In-network out-of-pocket maximum | $5,950.00 |
| Drug deductible | $299.00Tier 1 and 2 exempt |
| Drug out-of-pocket threshold | $2,400.00 |
| Plan type | HMO |
| Contract / plan | H3012-001-0 |
| Offered by | St. Luke's Health Plan |
| Parent organization | St. Luke's Health System, Inc. |
| Formulary tiers | 5 |
| Member services | (833)840-1216TTY 711 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- —
Published per contract — every plan under contract H3012 shares this rating.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 · Preferred Generic | $0.00 |
| Tier 2 · Generic | $5.00 |
| Tier 3 · Preferred Brand | 25% |
| Tier 4 · Non-Preferred Drug | 35% |
| Tier 5 · Specialty Tier | 30% |
Also available in 2 other ID counties
Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.