2021 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | EmblemHealth VIP Rx Plus (PDP) by EmblemHealth Medicare PDP | ||||
State: | New York | ||||
Plan ID: | S5966 - 004 - 0 Click to see other plans | ||||
Member Services: | 1-877-444-7241 TTY users 711 | ||||
— 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 EmblemHealth VIP Rx Plus (PDP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $72.50 (see Plan Premium Details below) | ||||
Annual Deductible: | $285 (Tier 1, 2 and 3 excluded from the Deductible.) | ||||
$0 Premium if LIS Benefits? | No, this plan does NOT qualify for the $0 Premium. (See premiums for partial LIS subsidy below.) | ||||
Annual Initial Coverage Limit (ICL): | $3,970 | ||||
Drug Benefit Type ❔ | Enhanced Alternative (EA) | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,466 drugs | Browse the EmblemHealth VIP Rx Plus (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: | $0.00 | $0.00 | $35.00 | $95.00 | 28% |
• Number of Drugs per Tier: | 320 | 1782 | 285 | 400 | 679 |
Plan Offers Mail Order? | Yes | ||||
Plan Type (Reach): | Regional Plan | ||||
Number of Members enrolled in this plan in New York: | 3,090 members (CMS Region 03) | ||||
Number of Members enrolled in this plan nationally: | 2,785 members | ||||
Plan’s Summary Star Rating: | 3 out of 5 Stars. | ||||
• Customer Service Rating: | 2 out of 5 Stars. | ||||
• Member Experience Rating: | 4 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 Basic Premium | Part D Supplemental Premium | ||
$72.50 | $49.70 | $22.80 | |||
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ | 100% Subsidy | 75% Subsidy | 50% Subsidy | 25% Subsidy | |
Monthly Part D Premium with LIS: | $30.20 | $40.80 | $51.40 | $61.90 |