• Alternative to Original Medicare Coverage
• ConnectiCare VIP Medicare Advantage
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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 Option 1 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 Copay	$5	$10	$7.50	$5	$10	$15	$2.50	$5	$7.50
  Tier 2: Preferred Brand Drugs Copay	$25	$50	$37.50	$25	$50	$75	$12.50	$25	$37.50
  Tier 3: Non-Preferred Drugs Coinsurance	50%	50%	50%	50%	50%	50%	50%	50%	50%
  Tier 4: Specialty Drugs Coinsurance	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 Drugs	After your costs exceed $4,350 Generic and Preferred Brand Drugs
  All Other Drugs	The greater of: $6.00 for all other drugs, or 5% coinsurance

  
  

  With ConnectiCare VIP Option plans, you can seek coverage from one of ConnetiCare's broad network of providers, or from a Medicare approved provider. You may have a reduced cost shares using ConnectiCare participating providers. 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.
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  • 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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