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2022 Medicare Prescription Drug Plan Benefit Details for the Clear Spring Health Value Rx (PDP) - S6946-022
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2022 Medicare Prescription Drug Plan Details
Medicare Plan Name:Clear Spring Health Value Rx (PDP)
   by Clear Spring Health
State:North Dakota
Plan ID:S6946 - 022 - 0     Click to see other plans
Member Services:1-877-317-6082 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
Email a copy of the Clear Spring Health Value Rx (PDP) benefit details
— Medicare Plan Features —
Monthly Premium:$29.30 (see Plan Premium Details below)
Annual Deductible:$480
$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):$4,430
Drug Benefit Type ❔Actuarially Equivalent Standard (AE)
Additional Gap Coverage?No additional gap coverage, only the Donut Hole Discount
Total Number of Formulary Drugs:3,142 drugsBrowse the Clear Spring Health Value 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:		$1.00$3.00$42.0040%25%
• Number of Drugs per
  Tier:		2095935041248588
Plan Offers Mail Order?Yes
Medicare Plan Pharmacy Numbers: BIN: 610014   PCN: MEDDPRIME   See BIN/PCNs for all plans
Plan Type (Reach):Regional Plan
Number of Members enrolled in this plan in North Dakota:482 members
Number of Members enrolled in this plan in your CMS Region:11,107 members     (CMS Region 25)
Number of Members enrolled in this plan nationally:201,352 members
Plan’s Summary Star Rating: 2 out of 5 Stars.
• Customer Service Rating: 1 out of 5 Stars.
• Member Experience Rating: 4 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
$29.30$29.30$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$7.30$14.60$22.00




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