AdvantraRx
Benefit Plan
Comparison Chart
01-01-2008
This section
provides specific
information
(including premiums
and cost sharing) on
the AdvantraRx plans
available in your
region.
To learn more
about why AdvantraRx
is a good choice for
you, click the link
on the left side of
this page. We’ve
also provided a link
to background
information on
Coventry Health
Care.
The following
chart contains
specific information
on the plans
available in your
region:
After your yearly
out-of-pocket drug
costs reach $4,050,
you pay the greater
of $2.25 for generic
or preferred brand
drug that is a
multi-source drug
and $5.60 for all
other drugs, or 5%
coinsurance.
Co-payment amounts
for mail order are
calculated based on
two co-payments even
though you receive a
3 month supply.
If you qualify
for extra help with
your Medicare
Prescription Drug
Plan costs, your
premium and drug
costs will be lower.
When you join
AdvantraRx,
Medicare will tell
us how much extra
help you are
getting. Then we
will let you know
the amount you will
pay. If you aren’t
getting any extra
help you can see if
you qualify by
calling
1-800-MEDICARE
(1-800-633-4227).
TTY/TDD users should
call 1-877-486-2048
(24 hours a day/7
days a week) or,
your State Medicaid
Office, or the
Social Security
Administration at
1-800-772-1213
between 7 a.m. and 7
p.m., Monday through
Friday. TTY/TDD
users should call
1-800-325-0778.
