• Alternative to Original Medicare Coverage
• ConnectiCare VIP Medicare Advantage
• The ConnectiCare
  Difference
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ConnectiCare VIP Medicare Advantage Plans

• • VIP Prime Plans
  • VIP Prime Drug Coverage
  • VIP Custom 1 Plan
  • VIP Custom 1 Drug Coverage
  • VIP Option Plans
  • VIP Option Drug Coverage
  • Compare All Plans
  • Helpful Questions
  • Evidence of Coverage
  • Summary of Benefits
  • Exceptions & Appeals
  

• ConnectiCare VIP Prime 1, 2, 3 Prescription Drug Coverage

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  	Preferred Pharmacy			Non-Preferred Pharmacy			Mail Order
  Supply	30 days	60 days	90 days	30 days	60 days	90 days	30 days	60 days	90 days
  Annual Deductible	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE	NONE
  Initial Drug Coverage Limit Total drug cost paid by member and plan	$2,700	$2,700	$2,700	$2,700	$2,700	$2,700	$2,700	$2,700	$2,700
  Tier 1: Preferred Generic Drugs	$5	$10	$7.50	$5	$10	$15	$2.50	$5	$7.50
  Tier 2: Preferred Brand Drugs	$25	$50	$37.50	$25	$50	$75	$12.50	$25	$37.50
  Tier 3: Non-Preferred Drugs	50%	50%	50%	50%	50%	50%	50%	50%	50%
  Tier 4: Specialty Drugs	33%	33%	33%	33%	33%	33%	33%	33%	33%
  Coverage Through Gap Tier 1 Preferred Generic Drugs Copay	$5	$10	$7.50	$5	$10	$15	$2.50	$5	$7.50
  Catastrophic Drug Coverage After your costs exceed $4,350 Generic and Preferred Brand	The greater of: $2.40 for generic (including drugs treated as generic), or 5% coinsurance
  All Other Drugs	The greater of: $6.00 for all other drugs, or 5% coinsurance

  
  

  Unless otherwise noted, all services must be provided by a ConnectiCare contracted provider for the ConnectiCare VIP Prime (In-network) plans. If you obtain routine care from out-of-plan providers, neither Medicare nor ConnectiCare will be responsible for the costs. Beneficiary can only be enrolled in one prescription drug plan at a time. This is not a complete list of drugs covered by the Part D Plan. For a complete list of benefits, please call ConnectiCare toll-free at 1-877-224-8221 (TTY/TDD 1-800-842-9710 for the hearing and speech impaired) Monday - Friday, 8 am - 8 pm and request the Summary of Benefits document or click here. Extended call hours 11/15 - 3/1, 8 am - 8 pm, seven days a week.

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  • Helpful Questions

    Here are some helpful questions so you can choose a ConnectiCare Medicare plan that really fits you.
    Learn about your options

  • Compare All Plans

    When you look at all of the plans ConnectiCare offers, you'll see that we're all about options. That's an advantage over Original Medicare alone.
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  • For More Information

    Call toll-free: 1-877-224-8221 (TTY/TDD 1-800-842-9710), Monday - Friday, 8 am - 8 pm. Extended hours 11/15 - 3/1, 8 am - 8 pm, 7 days a week.

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