2014 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | Symphonix Rite Aid Value Rx (PDP) by Symphonix Health | ||||
State: | Colorado | ||||
Plan ID: | S0522 - 028 - 0 Click to see other plans | ||||
Member Services: | 1-855-355-2280 TTY users 1-855-355-2280 | ||||
— 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 Symphonix Rite Aid Value Rx (PDP) benefit details
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— Medicare Plan Features — | |||||
Monthly Premium: | $32.40 | ||||
Annual Deductible: | $310 | ||||
$0 Premium if Full LIS Benefits? | No, this plan does NOT qualify for the $0 Premium. | ||||
Annual Initial Coverage Limit (ICL): | $2,850 | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,552 drugs | Browse the Symphonix Rite Aid Value Rx (PDP) Formulary | |||
This plan has 5 drug tiers.
See cost-sharing for all pharmacies and tiers.
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Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $1.00 | $10.00 | $29.00 | $85.00 | 25% |
• Number of Drugs per Tier: | 1392 | 325 | 379 | 915 | 541 |
Plan Offers Mail Order? | Yes | ||||
Plan Type (Reach): | Regional Plan | ||||
Number of Members enrolled in this plan in Colorado: | 311 members (CMS Region 27) | ||||
Number of Members enrolled in this plan nationally: | 83,502 members | ||||
Plan’s Summary Star Rating: | New plan - No summary rating as of yet. | ||||
• Customer Service Rating: | New plan - not yet rated. | ||||
• Member Experience Rating: | New plan - not yet rated. | ||||
• Drug Cost Accuracy Rating: | New plan - not yet rated. |