CTPF 2027 MEDICARE HEALTH INSURANCE HANDBOOK
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20
*Non-preferred network copays are $5 more than stated copays
UnitedHealthcare Group Medicare Advantage PPO
with Express Scripts by Evernorth Health Services® (PDP)
for CTPF Medicare Advantage plan
BEHAVIORAL HEALTH SERVICES
Outpatient: 100% after deductible
Inpatient: 100% after deductible
(190 day lifetime limit)
PRESCRIPTION DRUG BENEFITS
Preferred Value Network Pharmacy*
(up to 31-Day supply)
$15 Generic copay
$45 Preferred brand copay
$65 Non-preferred brand copay
$65 Specialty drugs
Preferred Value Network Pharmacy*
(up to 90-day supply)
$37.50 Generic copay
$112.50 Preferred brand copay
$162.50 Non-preferred brand copay
$162.50 Specialty drugs
Express Scripts Mail Order (up to 90-Day Supply)
$30 Generic copay
$90 Preferred brand copay
$130 Non-preferred brand copay
$130 Specialty drugs
Annual Brand Prescription Deductible $200
Coverage
Prescription coverage is provided through the Initial Coverage
stage and generally stays the same as the copays listed above.
For 2027, you will stay in this stage until the total cost of your
Part D drugs reaches $2,400. Once you reach this limit, you
move on to the Catastrophic Coverage stage. Most members
will not reach the Catastrophic Coverage stage.
Non-Medicare Part D drugs are not covered (for example,
lifestyle drugs for ED).
Medicare Part B drugs: use UnitedHealthcare Medicare
Advantage ID card.
Vaccinations
Flu shots and shots to prevent pneumococcal
infections are covered under Part B. Contact
UnitedHealthcare Medicare Advantage customer
service for more information on vaccines and other Part B
services.
Important Pharmacy Notes
Once your true out-of-pocket cost reaches $2,400,
your copay will be reduced. Once you meet this cost threshold,
the plan pays the full cost for your covered Part D drugs. If your
plan covers additional drugs not normally covered by Medicare,
you may have a cost share for such drugs covered under an
enhanced benefit.
Humana Group Medicare HMO
with Part D Pharmacy Medicare Advantage plan
BEHAVIORAL HEALTH SERVICES
Outpatient: $10 copay PCP, $25 copay specialist, $40
copay outpatient facility
Inpatient: $150 copay per day (days 1-5) in-network,
per admission; authorized services only. Inpatient
psychiatric care: 190 day lifetime limit. Alcohol and
substance abuse: $150 copay per day (days 1-5)
in-network, per admission.
PRESCRIPTION DRUG BENEFITS
Retail Pharmacy (up to 30-Day supply)
$5 Preferred generic copay
$30 Non-preferred generic or preferred brand copay
$45 Non-preferred brand copay
25% Coinsurance for specialty drugs (limited to a
30-Day supply, max. $150 per prescription)
30-day mail order supply also available with $5
preferred generic copay. All other copays same as
retail 30-day supply.
Retail up to 100-Day Supply
$15 Preferred generic copay
$90 Non-preferred generic or preferred brand copay
$135 Non-preferred brand copay
Mail Order up to 100-Day Supply
$0 Preferred generic copay
$60 Non-preferred generic or preferred brand copay
$90 Non-preferred brand copay
Vaccinations
Flu shots and shots to prevent pneumococcal
infections are covered under Part B. Contact Humana
customer service for more information about vaccines
and other Part B services.
Important Pharmacy Notes
When the member's cost share plus the costs incurred
for Part D drugs reimbursed through insurance or a
group health plan reaches $2,400, you have a $0 copay.
Plan Comparisons: Medicare-Eligible Members
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