2018 Medicare Prescription Drug Plan Details | |||||
---|---|---|---|---|---|
Medicare Plan Name: | Symphonix Value Rx (PDP) by UnitedHealthcare | ||||
State: | Mississippi | ||||
Plan ID: | S0522 - 024 - 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 |
||||
Email a copy of the Symphonix Value Rx (PDP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $22.80 (see Plan Premium Details below) | ||||
Annual Deductible: | $405 | ||||
$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): | $3,750 | ||||
Drug Benefit Type ❔ | Actuarially Equivalent Standard (AE) | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,277 drugs | Browse the Symphonix Value Rx (PDP) Formulary | |||
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $1.00 | $3.00 | $28.00 | 34% | 25% |
• Number of Drugs per Tier: | 134 | 779 | 713 | 1045 | 606 |
Plan Offers Mail Order? | Yes | ||||
Plan Type (Reach): | National Plan | ||||
Number of Members enrolled in this plan in Mississippi: | 6,463 members (CMS Region 20) | ||||
Number of Members enrolled in this plan nationally: | 735,860 members | ||||
Plan’s Summary Star Rating: | 3 out of 5 Stars. | ||||
• Customer Service Rating: | 4 out of 5 Stars. | ||||
• Member Experience Rating: | 2 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 Basic Premium | Part D Supplemental Premium | ||
$22.80 | $22.80 | $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 | $5.70 | $11.40 | $17.10 |