2010 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | CIGNA Medicare Rx Plan One (PDP) by CIGNA Medicare Rx | ||||
State: | Wisconsin | ||||
Plan ID: | S5617 - 223 - 0 Click to see other plans | ||||
Member Services: | 1-800-222-6700 TTY users 1-800-322-1451 | ||||
— This plan information is for research purposes only. — Click here to see plans for the current plan year | |||||
Medicare Contact Information: | Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. TTY users 1-877-486-2048 or contact your local SHIP for assistance |
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Email a copy of the CIGNA Medicare Rx Plan One (PDP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $33.70 | ||||
Annual Deductible: | $310 | ||||
$0 Premium if LIS Benefits? | Yes, this plan does qualify for the $0 Premium. | ||||
Annual Initial Coverage Limit (ICL): | $2,830 | ||||
Drug Benefit Type ❔ | Actuarially Equivalent Standard (AE) | ||||
Gap Coverage? | No Gap Coverage | ||||
Total Number of Formulary Drugs: | 3,458 drugs | Browse the CIGNA Medicare Rx Plan One (PDP) Formulary | |||
This plan has 4 drug tiers. See cost-sharing highlights below. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $3.00 | $34.00 | $87.00 | 25% | |
• Number of Drugs per Tier: | 1513 | 1117 | 445 | 383 | |
Plan Offers Mail Order? | Yes | ||||
Plan Type (Reach): | National Plan | ||||
Number of Members enrolled in this plan in Wisconsin: | 9,251 members (CMS Region 16) | ||||
Number of Members enrolled in this plan nationally: | 379,722 members |