2018 TakeCare RX Plus (PDP) S8899-2-0 in MP from TAKECARE INSURANCE COMPANY, INC. | HealthPocket

TakeCare RX Plus (PDP)

$632/mo

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Zip Code
Applicant10/16/1983 Male
Coverage Start10/17/2018
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Benefits & Coverage

Insurance TypeMedicare Advantage Prescription Drug Plan (Part D)
Insurance ProviderTAKECARE INSURANCE COMPANY, INC.
Plan IDS8899-2-0
Plan Year2018
CMS RatingNot Rated
Plan TypePDP
Annual Deductible$405.00

What To Know About This Plan
  • This is a drug coverage only plan

Costs and Other Important Information

Plan Year2018
Prescription Drugs Covered?Yes
Health Plan Deductible$405
Monthly Drug Plan Premium$52.7
Monthly Health Plan Premium$0

Coverage Area for TakeCare RX Plus (PDP)

StateNorthern Mariana Islands
County

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$2.5 copay$5 copayNot offered
Tier 2: Non-Preferred Generic$7 copay$14 copayNot offered
Tier 3: Preferred Brand Name$45 copay$45 copayNot offered
Tier 4: Non-Preferred Brand Name39% coinsurance39% coinsuranceNot offered
Tier 5: Specialty Tier25% coinsurance25% coinsuranceNot offered

60 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$5 copay$10 copayNot offered
Tier 2: Non-Preferred Generic$14 copay$28 copayNot offered
Tier 3: Preferred Brand Name$90 copay$90 copayNot offered
Tier 4: Non-Preferred Brand Name39% coinsurance39% coinsuranceNot offered
Tier 5: Specialty Tier25% coinsurance25% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$7.5 copay$15 copayNot offered
Tier 2: Non-Preferred Generic$21 copay$42 copayNot offered
Tier 3: Preferred Brand Name$135 copay$135 copayNot offered
Tier 4: Non-Preferred Brand Name39% coinsurance39% coinsuranceNot offered
Tier 5: Specialty Tier25% coinsurance25% coinsuranceNot offered

Pharmacies that accept TakeCare RX Plus (PDP) Prescription Drug Plan for Northern Mariana Islands

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