2023 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | Clear Spring Health Value Rx (PDP) by Clear Spring Health | ||||
State: | California | ||||
Plan ID: | S6946 - 027 - 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 | |||||
— This plan was sanctioned in 2023 — Read more here... | |||||
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 Clear Spring Health Value Rx (PDP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $25.80 (see Plan Premium Details below) | ||||
Annual Deductible: | $505 | ||||
$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): | $4,660 | ||||
Drug Benefit Type ❔ | Actuarially Equivalent Standard (AE) | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,157 drugs | Browse the Clear Spring Health Value Rx (PDP) Formulary | |||
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers. | |||||
Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $1.00 | $3.00 | $42.00 | 35% | 25% |
• Number of Drugs per Tier: | 183 | 533 | 598 | 1237 | 606 |
Plan Offers Mail Order? | Yes | ||||
Medicare Plan Pharmacy Numbers: | BIN: 610014 PCN: MEDDPRIME See BIN/PCNs for all plans | ||||
Plan Type (Reach): | National Plan | ||||
Number of Members enrolled in this plan in California: | 136,673 members (CMS Region 32) | ||||
Number of Members enrolled in this plan nationally: | 344,163 members | ||||
Plan’s Summary Star Rating: | 1.5 out of 5 Stars. | ||||
• Customer Service Rating: | 1 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 Basic Premium | Part D Supplemental Premium | ||
$25.80 | $25.80 | $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 | $6.40 | $12.90 | $19.30 |