Plan

INFORMATION

Plan Information

2020 Prescription Coverage

Copays or Coinsurance

All drugs on HealthTeam Advantage’s drug list are in one of five cost-sharing tiers for the PPO plans and six cost-sharing tiers for the HMO CSNP plan. Below is a summary of copays depending on drug tier and plan:

Standard In-Network Retail or Mail-Order
(up to a 30-day supply)		Standard In-Network Retail or Mail-Order
(up to a 90-day supply)
HealthTeam Advantage Plan I (PPO)
Tier 1 – Preferred Generics
Tier 2 – Generics
Tier 3 – Preferred Brands
Tier 4 – Non-Preferred Drugs
Tier 5 – Specialty Drugs		$5 copay
$15 copay
$45 copay
$90 copay
33% coinsurance		$10 copay
$30 copay
$90 copay
$180 copay
33% coinsurance
HealthTeam Advantage Plan II (PPO)
Tier 1 – Preferred Generics
Tier 2 – Generics
Tier 3 – Preferred Brands
Tier 4 – Non-Preferred Drugs
Tier 5 – Specialty Drugs		$0 copay
$12 copay
$40 copay
$80 copay
33% coinsurance		$0 copay
$24 copay
$80 copay
$160 copay
33% coinsurance
HealthTeam Advantage diabetes and Heart Care (HMO CSNP)
Tier 1 – Preferred Generics
Tier 2 – Generics
Tier 3 – Preferred Brands
Tier 4 – Non-Preferred Drugs
Tier 5 – Specialty Drugs
Tier 6 – Select Care Drugs		$0 copay
$15 copay
$45 copay
$90 copay
33% coinsurance
$0 		$0 copay
$30 copay
$90 copay
$180 copay
33% coinsurance
$0

Definition of the five drug tiers:

  • Tier 1 – Preferred Generics: Generic drugs that are available at the lowest cost share
  • Tier 2 – Generics: Generic and some very low-cost brand drugs that are available at a higher cost to you than drugs in Tier 1
  • Tier 3 – Preferred Brands: Generic or brand drugs that are available at a lower cost to you than drugs in Tier 4
  • Tier 4 – Non-Preferred Drugs: Generic or brand drugs that are available at a higher cost to you than drugs in Tier 3
  • Tier 5 – Specialty Drugs: This is the highest-cost tier. Some injectables and other high-cost drugs
  • Tier 6 – Specialty Drugs: Generic or brand drugs that are used to treat or prevent conditions. Specifically, diabetes, cardiovascular disease and most vaccines.

Extra Help

You may be able to get extra help pay for your prescription drug premiums and costs. To see if you qualify, call or contact:

For more information about gap coverage or other prescription drug benefits, please see your:

Page last updated: Oct 9, 2019

HealthTeam Advantage, a product of Care N’ Care Insurance Company of North Carolina, Inc., is a Medicare Advantage organization with a Medicare contract. Enrollment in HealthTeam Advantage depends on contract renewal. You must continue to pay your Medicare Part B premium. This information is not a complete description of benefits. Contact the plan for more information. Certain plan materials are also available in large print and braille for individuals who need accommodations. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

HealthTeam Advantage, 7800 McCloud Road, Suite 100, Greensboro, NC 27409.

To learn more, please call 1-877-905-9216 (TTY: 711) from October 1 – March 31, 8 a.m. to 8 p.m. ET, seven days a week, or April 1 – September 30, 8 a.m. to 8 p.m. ET, Monday through Friday.