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2021 Medicare Prescription Drug Plan Benefit Details for the Cigna Secure-Essential Rx (PDP)
2021 Medicare Prescription Drug Plan Details
Medicare Plan Name:Cigna Secure-Essential Rx (PDP)
   by Cigna
State:Wisconsin
Plan ID:S5617 - 295 - 0     Click to see other plans
Member Services:1-800-222-6700 TTY users 711
— Enrollment Options —
Medicare Contact Information:1-800-MEDICARE (1-800-633-4227)
TTY users 1-877-486-2048
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Call Medicare Solutions at 855-373-9484 / TTY 711
Monday ‐ Friday 8:30am — 10pm EST
MULTIPLAN_GHHJTEXEN_ACCEPTED
Email a copy of the Cigna Secure-Essential Rx (PDP) benefit details
— Medicare Plan Features —
Monthly Premium:$24.00 (see Plan Premium Details below)
Annual Deductible:$445 (Tier 1 and 2 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):$4,130
Additional Gap Coverage?No additional gap coverage, only the Donut Hole Discount
Total Number of Formulary Drugs:3,140 drugsBrowse the Cigna Secure-Essential 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:		$0.00$2.0018%46%25%
• Number of Drugs per
  Tier:		1496935121313473
Plan Offers Mail Order?Yes
Medicare Plan Pharmacy Numbers: BIN: 017010   PCN: CIMCARE   See BIN/PCNs for all plans
Plan Type (Reach):National Plan
Number of Members enrolled in this plan in Wisconsin:7,359 members     (CMS Region 16)
Number of Members enrolled in this plan nationally:235,491 members
Plan’s Summary Star Rating: 3.5 out of 5 Stars.
• Customer Service Rating: 3 out of 5 Stars.
• Member Experience Rating: 5 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 Base
Premium		Part D Supplemental
Premium
$24.00$8.80$15.20
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔100%
Subsidy		75%
Subsidy		50%
Subsidy		25%
Subsidy
Monthly Part D Premium with LIS:$15.20$17.40$19.60$21.80


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