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2015 Medicare Prescription Drug Plan Benefit Details for the EnvisionRxPlus Silver (PDP) - S7694-031

This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2015 Medicare Prescription Drug Plan Details
Medicare Plan Name:EnvisionRxPlus Silver (PDP)
   by EnvisionRx Plus
State:Idaho
Plan ID:S7694 - 031 - 0     Click to see other plans
Member Services:1-866-250-2005 TTY users 1-866-763-9630
— 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
Email a copy of the EnvisionRxPlus Silver (PDP) benefit details
— Medicare Plan Features —
Monthly Premium:$38.20 (see Plan Premium Details below)
Annual Deductible:$320 (Some Tiers exempt, details coming soon.)
$0 Premium if LIS Benefits?Yes, this plan does qualify for the $0 Premium. (See premiums for partial LIS subsidy below.)
Annual Initial Coverage Limit (ICL):$2,960
Drug Benefit Type Actuarially Equivalent Standard (AE)
Additional Gap Coverage?No additional gap coverage, only the Donut Hole Discount
Total Number of Formulary Drugs:2,971 drugsBrowse the EnvisionRxPlus Silver (PDP) Formulary
This plan has 4 drug tiers. See cost-sharing for all pharmacies and tiers
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:
$2.0015%35%25% 
Number of Drugs per
  Tier:
11013571324189
Plan Offers Mail Order?Yes
Plan Type (Reach):Regional Plan
Number of Members enrolled in this plan in Idaho:1,648 members
Number of Members enrolled in this plan in your CMS Region:3,409 members     (CMS Region 31)
Number of Members enrolled in this plan nationally:384,467 members
Plan’s Summary Star Rating: 3.5 out of 5 Stars.
Customer Service Rating: 5 out of 5 Stars.
Member Experience Rating: 4 out of 5 Stars.
Drug Cost Accuracy Rating: 3 out of 5 Stars.
— Plan Premium Details —
The Monthly Premium is Split as Follows:
Total
Premium
Part D Basic
Premium
Part D Supplemental
Premium
$38.20$38.20$0.00
Monthly Premium with Extra Help Low-Income Subsidy (LIS): 100%
Subsidy
75%
Subsidy
50%
Subsidy
25%
Subsidy
Monthly Part D Premium with LIS:$0.00$9.50$19.10$28.60





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