2016 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | EnvisionRxPlus Silver (PDP) by EnvisionRx Plus | ||||
State: | Oklahoma | ||||
Plan ID: | S7694 - 023 - 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 |
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Email a copy of the EnvisionRxPlus Silver (PDP) benefit details
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— Medicare Plan Features — | |||||
Monthly Premium: | $33.90 (see Plan Premium Details below) | ||||
Annual Deductible: | $360 (Tier excluded from the Deductible.) | ||||
$0 Premium if Full LIS Benefits? | No, this plan does NOT qualify for the $0 Premium. (See premiums for partial LIS subsidy below.) | ||||
Annual Initial Coverage Limit (ICL): | $3,310 | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,074 drugs | Browse the EnvisionRxPlus Silver (PDP) Formulary | |||
This plan has 4 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: | $2.00 | 12% | 40% | 25% | |
• Number of Drugs per Tier: | 1093 | 448 | 1101 | 432 | |
Plan's Pharmacy Search: | https://www.envisionrxplus.com/en/pharmacy.aspx | ||||
Plan Offers Mail Order? | Yes | ||||
Plan Type (Reach): | National Plan | ||||
Number of Members enrolled in this plan in Oklahoma: | 1,110 members (CMS Region 23) | ||||
Number of Members enrolled in this plan nationally: | 316,892 members | ||||
Plan’s Summary Star Rating: | 3 out of 5 Stars. | ||||
• Customer Service Rating: | 2 out of 5 Stars. | ||||
• Member Experience Rating: | 3 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 2 out of 5 Stars. | ||||
— Plan Premium Details — | |||||
The Monthly Premium is Split as Follows: ❔ | Total Premium | Part D Base Premium | Part D Supplemental Premium | ||
$33.90 | $33.90 | $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: | $3.20 | $10.90 | $18.50 | $26.20 |