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Medicare Plan Details (2023 Plan)


Monthly Premium

 

by UnitedHealthcare
Additional Coverage

(none)

Overall Government Star Rating
 3.0
out of 5 stars

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Plan Type

Prescription Drug (Part D)

 

$32
$350.00
No

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$16.00 copay


Generic drugs :
$4.15 copay or 5% (whichever costs more)

Brand-name drugs :
$10.35 copay or 5% (whichever costs more)

Generic$20.00 copay$20.00 copay
Preferred Brand$45.00 copay
Non-Preferred Drug50%
Specialty Tier27%
1 * The above cost-sharing only applies to some drugs on this tier. For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

Not covered
Not covered
 3
 5
 4
 2
 2

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