Our Advantage I MAPD and Dual Preferred SNP plans both use a formulary. The plan will send you the formulary. You can also view the formulary on the website by clicking here.
Different out-of-pocket costs may apply for people who
- have limited incomes,
- live in long term care facilities, or
- have access to Indian/Tribal/Urban (Indian Health Service).
The plan offers national in-network prescription coverage. This means that you will pay the same amount for your prescription drugs if you get them at an in- network pharmacy outside of the plan's service area (for instance when you travel).
Total yearly drug costs are the total drug costs paid by both you and the plan. The plan may require you to first try one drug to treat your condition before it will cover another drug for that condition.
Some drugs have quantity limits. Your provider must get prior authorization from MD Care Advantage I for certain drugs. If the actual cost of a drug is less than the normal copay amount for that drug, you will pay the actual cost, not the higher copay amount.
|Retail Pharmacy||$3 copay for a one-month (30-day) supply|
$6 copay for a three-month (90-day) supply
|$25 copay for a one-month (30-day) supply|
$50 copay for a three-month (90-day) supply
|$59 copay for a one-month (30-day) supply|
$118 copay for a three-month (90-day) supply
|33% coinsurance for a one-month (30-day) supply|
33% coinsurance for a three-month (90-day) supply
|Long Term Care Pharmacy||$3 copay for a one-month (31-day) supply||$25 copay for a one-month (31-day) supply||$59 copay for a one-month (31-day) supply||33% coinsurance for a one-month (31-day) supply|
|Mail Order||$6 copay for a three-month (90-day) supply||$50 copay for a three-month (90-day) supply||$118 copay for a three-month (90-day) supply||33% coinsurance for a three-month (90-day) supply|
|$3 copay for a (10-day) supply||$25 copay for a (10-day) supply||$59 copay for a (10-day) supply||33% coinsurance for a (10-day) supply|
During the Coverage Gap Stage, you pay $3 copay for generic drugs and you receive a 50% discount on brand name drugs. You will get a 10-day supply for drugs filled at an out-of-network pharmacy.
After your yearly out-of-pocket drug costs reach $4,700, you pay the greater of:
- $2.50 for generic (including brand drugs treated as generic) and $6.30 for all other drugs, or
- 5% coinsurance.
You will get a 10-day supply for drugs filled at an out-of-network pharmacy.
A Medicare Advantage organization with a Medicare contact. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information cont the plan. Benefits, formulary, pharmacy network, premium and or co-payments/co-insurance may change on January 1, 2013. You must continue to pay your Medicare Part B premium. Limitations, copayments, and restrictions may apply. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or Your State Medicaid Office.
Copays and co-insurance may vary based on the level of Extra help that you may receive. Contact MD Care Healthplan at 1 (888) 285-9676, TTY/TDD users should call 1 (800) 735-2929 for further details. Our hours of operation are 8AM to 8PM 7 days a week October 15th through March 1st, and 8AM to 8PM Monday through Friday after March 1st.