|Medicare Prescription Drug Plan Benefit Details in Plain Text|
|The following Medicare Prescription Drug plan (PDP) benefits apply to the Clear Spring Health Premier Rx (PDP) (S6946 - 037) in CMS Region 11, which includes all counties in FL.|
This plan is administered by CLEAR SPRING HEALTH INSURANCE COMPANY, 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 Clear Spring Health Premier Rx (PDP) prescription drug benefit details in chart format
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|The Clear Spring Health Premier Rx (PDP) has a monthly premium of $13.50. That is $162.00 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).|
|The Clear Spring Health Premier Rx (PDP) (S6946 - 037) in CMS Region 11 currently has 12,565 members, and 201,342 members in the Clear Spring Health Premier Rx (PDP) nationwide.|
|Prescription Drug Coverage: Deductible, Cost-sharing, Formulary|
|This plan has a $445 deductible. However, formulary drugs on Tier 1 and 2 are excluded from the $445 deductible and have first dollar coverage (or a $0 deductible). So, you are 100% responsible for the first $445 in medication costs for drugs not on the excluded tiers. After you have met the deductible, the Clear Spring Health Premier Rx (PDP) will share the costs of your medications with you -- see cost-sharing below. $445 is the maximum deductible for 2021. 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 Clear Spring Health Premier Rx (PDP) formulary (or drug list). There are 3297 drugs on the Clear Spring Health Premier Rx (PDP) formulary. |
The Clear Spring Health Premier Rx (PDP) does offer a mail order service.
Click here to browse the Clear Spring Health Premier 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 $445, 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 Clear Spring Health Premier 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: |
The Clear Spring Health Premier Rx (PDP)’s Initial Coverage Limit is $4,130. 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 75% of your generic drug prescription costs in the donut hole on your behalf. |
The brand-name drug manufacturer will pay 70% 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 75% discount. The 70% 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 (Clear Spring Health Premier Rx (PDP)) offers No Coverage during the Coverage Gap phase.