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

2016 Symphonix PrimeSaver Rx (PDP)

Medicare Prescription Drug Plan Benefit Details in Plain Text
The following Medicare Prescription Drug plan (PDP) benefits apply to the Symphonix PrimeSaver Rx (PDP) (S0522 - 059) in CMS Region 15, which includes all counties in IN KY.

This plan is administered by SYMPHONIX HEALTH INSURANCE, INC., 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 Symphonix PrimeSaver Rx (PDP) prescription drug benefit details in chart format or email and view benefits chart

Plan Premium
The Symphonix PrimeSaver Rx (PDP) has a monthly premium of $38.80. That is $465.60 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 Symphonix PrimeSaver Rx (PDP) (S0522 - 059) in CMS Region 15 currently has 532 members, and 10,437 members in the Symphonix PrimeSaver Rx (PDP) nationwide.

The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 2.5 stars. The detail CMS plan carrier ratings are as follows:
Prescription Drug Coverage: Deductible, Cost-sharing, Formulary
This plan has a $200 deductible. However, formulary drugs on Tier 1 and 2 are excluded from the $200 deductible and have first dollar coverage (or a $0 deductible). So, you are 100% responsible for the first $200 in medication costs for drugs not on the excluded tiers. After you have met the deductible, the Symphonix PrimeSaver Rx (PDP) will share the costs of your medications with you (see cost-sharing below). The maximum deductible for 2016 is $360, but this plan (Symphonix PrimeSaver Rx (PDP)) has a $200. 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 Symphonix PrimeSaver Rx (PDP) formulary (or drug list). There are 3731 drugs on the Symphonix PrimeSaver Rx (PDP) formulary.

The Symphonix PrimeSaver Rx (PDP) does offer a mail order service.

Click here to browse the Symphonix PrimeSaver Rx (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 $200, 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 Symphonix PrimeSaver Rx (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:
  • Tier 1 (Preferred Generic) contains 193 drugs and has a co-payment of $1.00.
  • Tier 2 (Generic) contains 782 drugs and has a co-payment of $6.00.
  • Tier 3 (Preferred Brand) contains 816 drugs and has a co-insurance of 20% of the drug cost.
  • Tier 4 (Non-Preferred Brand) contains 1,204 drugs and has a co-insurance of 40% of the drug cost.
  • Tier 5 (Specialty Tier) contains 736 drugs and has a co-insurance of 28% of the drug cost.
    •  
Click here to browse the Symphonix PrimeSaver Rx (PDP) Formulary.

The Symphonix PrimeSaver Rx (PDP)’s Initial Coverage Limit is $3,310. 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 42% 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 5% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 55% 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 (Symphonix PrimeSaver Rx (PDP)) offers No Coverage during the Coverage Gap phase.





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  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
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