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2021 Medicare Prescription Drug Plan Benefit Details for the Elixir RxPlus (PDP)
2021 Medicare Prescription Drug Plan Details
Medicare Plan Name:Elixir RxPlus (PDP)
   by Elixir Insurance
State:Wisconsin
Plan ID:S7694 - 016 - 0     Click to see other plans
Member Services:1-866-250-2005 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
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Email a copy of the Elixir RxPlus (PDP) benefit details
— Medicare Plan Features —
Monthly Premium:$39.10 (see Plan Premium Details below)
Annual Deductible:$445
$0 Premium if Full LIS Benefits?Yes, this plan does 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:3,182 drugsBrowse the Elixir RxPlus (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:		$1.00$6.0015%25%25%
• Number of Drugs per
  Tier:		2066124931293578
Plan Offers Mail Order?Yes
Plan Type (Reach):National Plan
Number of Members enrolled in this plan in Wisconsin:8,608 members     (CMS Region 16)
Number of Members enrolled in this plan nationally:305,644 members
Plan’s Summary Star Rating: 3.5 out of 5 Stars.
• Customer Service Rating: 3 out of 5 Stars.
• Member Experience Rating: 2 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
$39.10$39.10$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$9.80$19.50$29.30


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