Which Alliance Medicare Rx option is right for you?
This chart summarizes and compares the key benefits for each option.

Download the Summary of Benefits
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	Rx Option 1	Rx Option 2
Premium	$40.50	$70.00
Deductible	$150 annually	$0
Initial coverage limit: Annual drug costs paid by you and the plan, combined, up to $2,830
Copay for 30-day supply	$8.00 generic $45.00 preferred brand $75.00 non-preferred 29% specialty	$5.00 generic $35.00 preferred brand $60.00 non-preferred $60.00 specialty
Copay for 90-day supply, Choice 90 retail, and mail-order during initial coverage	$20.00 generic $112.50 preferred brand $187.50 non-preferred 29% specialty	$12.50 generic $87.50 preferred brand $150.00 non-preferred $150.00 specialty
Coverage gap (Donut hole)	Alliance negotiated prices	Alliance negotiated prices
Catastrophic coverage: Copay after you reach $4,550 in total out-of-pocket costs	$2.50 generic or 5% (whichever is greater) $6.30 all other drugs or 5% (whichever is greater)	$2.50 generic or 5% (whichever is greater) $6.30 all other drugs or 5% (whichever is greater)

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Learn more about our plans and plan premiums
Download the Alliance Medicare Rx booklet

Learn details and key components of our plans
Download the Summary of Benefits

Talk with an Alliance Medicare representative
Our experienced Alliance Medicare Rx representative can answer questions about coverage, our formulary, or pharmacies.

For enrollment and customer service, call toll-free:
(800) 868-3153 or
TDD (800) 956-4325

For prescriptions or drug benefits, call toll-free:
800) 765-3436 or
TDD (800) 956-4325

Office Hours:
Monday - Friday 8 a.m. to 8 p.m.
Saturday 8 a.m. to noon.
At all other times, you may access our Interactive Voice Recording system at the same number.

Extended hours from November 15 - March 1:
7 days a week, including holidays, 8 a.m. to 8 p.m.

Important information
Alliance Medicare Rx is a stand alone Prescription Drug Plan with a Medicare contract. Our Alliance Medicare Rx contract with Medicare is renewed annually. The availability of coverage beyond the end of the current contract year is not guaranteed.

The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; for more information contact the plan.