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2015 Medicare Prescription Drug Plan Benefit Details for the Symphonix Rite Aid Premier Rx (PDP)
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:Symphonix Rite Aid Premier Rx (PDP)
   by Symphonix Health
State:Idaho
Plan ID:S0522 - 064 - 0     Click to see other plans
Member Services: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
Email a copy of the Symphonix Rite Aid Premier Rx (PDP) benefit details
— Medicare Plan Features —
Monthly Premium:$86.60 (see Plan Premium Details below)
Annual Deductible:$0 (Some Tiers exempt, details coming soon.)
$0 Premium if LIS Benefits?No, this plan does NOT qualify for the $0 Premium. (See premiums for partial LIS subsidy below.)
Annual Initial Coverage Limit (ICL):$2,960
Drug Benefit Type ❔Enhanced Alternative (EA)
Additional Gap Coverage?Yes, some additional gap coverage.
Total Number of Formulary Drugs:4,018 drugsBrowse the Symphonix Rite Aid Premier Rx (PDP) Formulary
This plan has 5 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:		$2.00$4.00$30.00$70.0033%
• Number of Drugs per
  Tier:		12581913501052672
Plan Offers Mail Order?Yes
Plan Type (Reach):Regional Plan
Number of Members enrolled in this plan in Idaho:less than 10 members
Number of Members enrolled in this plan in your CMS Region:30 members     (CMS Region 31)
Number of Members enrolled in this plan nationally:1,372 members
Plan’s Summary Star Rating: Insufficient data to rate this plan.
• Customer Service Rating: Insufficient data to rate this plan.
• Member Experience Rating: Insufficient data to rate this plan.
• Drug Cost Accuracy Rating: Insufficient data to rate this plan.
— Plan Premium Details —
The Monthly Premium is Split as Follows: ❔
Total
Premium		Part D Basic
Premium		Part D Supplemental
Premium
$86.60$71.20$15.40
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔100%
Subsidy		75%
Subsidy		50%
Subsidy		25%
Subsidy
Monthly Part D Premium with LIS:$46.90$56.80$66.70$76.70




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