Medicare Prescription Drug Plan Benefit Details in Plain Text |
The following Medicare Prescription Drug plan (PDP) benefits apply to the EnvisionRxPlus Gold (PDP) (S7694 - 085) in CMS Region 15, which includes all counties in IN KY. This plan is administered by ENVISION INSURANCE COMPANY, a national plan provider. This means that the insurance carrier offers Medicare Part D plan in most every state. To switch to a different Medicare Prescription Drug plan or to change your location, click here. |
Click here to see the EnvisionRxPlus Gold (PDP) prescription drug benefit details in chart format
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Plan Premium |
The EnvisionRxPlus Gold (PDP) has a monthly premium of $54.50. That is $654.00 for 12 months. There are a few factors that can increase or decrease this premium. If you qualify for full or partial extra help, your premium will be lower. If you have a premium penalty, your premium will be higher. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA). |
Plan Membership and Plan Ratings |
The EnvisionRxPlus Gold (PDP) (S7694 - 085) in CMS Region 15 currently has 260 members, and 7,108 members in the EnvisionRxPlus Gold (PDP) nationwide. |
The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 3 stars. The detail CMS plan carrier ratings are as follows:
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Prescription Drug Coverage: Deductible, Cost-sharing, Formulary |
This plan has a $150 deductible. So, you are 100% responsible for the first $150 in medication costs. After you have met the deductible, the EnvisionRxPlus Gold (PDP) will share the costs of your medications with you (see cost-sharing below). The maximum deductible for 2013 is $325, but this plan (EnvisionRxPlus Gold (PDP)) has a $150. There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. Click here to review plans with a $0 deductible. |
The following information is about the EnvisionRxPlus Gold (PDP) formulary (or drug list). There are 2747 drugs on the EnvisionRxPlus Gold (PDP) formulary. The EnvisionRxPlus Gold (PDP) does offer a mail order service. Click here to browse the EnvisionRxPlus Gold (PDP) Formulary. |
The Initial Coverage Phase (ICP) can be thought of as the cost-sharing phase of the plan. During this phase, you and the insurance company share your prescription costs. Once you have spent $150, your initial coverage phase will start. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The EnvisionRxPlus Gold (PDP)’s formulary is divided into 5 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan is divided as follows:
The EnvisionRxPlus Gold (PDP)’s Initial Coverage Limit is $2,970. When this limit is reached, you exit the Initial Coverage Phase and enter the Coverage Gap (or Donut Hole). |
The Coverage Gap, which is also known as the Donut (Doughnut) Hole is the phase of your Medicare Part D plan where
you are responsible for 100% of your medication costs. Healthcare Reform mandates that the insurance carrier pay 21% of your generic drug prescription costs in the donut hole on your behalf. The brand-name drug manufacturer will pay 50% and your plan will pay an additional 2.5% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 52.5% discount. The 50% paid by the brand-name drug manufacturer is paid on your behalf and therefore counts toward your TrOOP (or True Out-of-Pocket) costs. The portion paid by your plan, does not count toward TrOOP. Some Medicare Part D plans offer coverage during the Coverage Gap that is beyond the mandated discounts. Any drug not covered by the plan’s Gap Coverage will still receive the discounts noted above -- even if the plan has "No Gap Coverage". This plan (EnvisionRxPlus Gold (PDP)) offers Coverage for Some Generics during the Coverage Gap phase. This means that some (10% to 65%) of the generic drugs on the plans formulary (or drug list) and no brand-name drugs will be covered through the coverage gap (or donut hole). |