2009 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | SierraRx Basic by Sierra Health and Life Insurance Company, Inc. | ||||
State: | Missouri | ||||
Plan ID: | S5917 - 020 - 0 Click to see other plans | ||||
Member Services: | 1-866-819-3450 TTY users 1-877-730-4203 | ||||
— 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 SierraRx Basic benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $64.40 | ||||
Annual Deductible: | $295 | ||||
$0 Premium if Full LIS Benefits? | No, this plan does NOT qualify for the $0 Premium. | ||||
Gap Coverage? | No Gap Coverage | ||||
Total Number of Formulary Drugs: | 2,469 drugs | Browse the SierraRx Basic Formulary | |||
This plan has 3 drug tiers. See cost-sharing highlights below. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | 25% | 25% | 25% | ||
• Number of Drugs per Tier: | 1709 | 547 | 213 | ||
Plan Offers Mail Order? | Yes | ||||
Plan Type (Reach): | National Plan | ||||
Number of Members enrolled in this plan in Missouri: | 102 members (CMS Region 18) | ||||
Number of Members enrolled in this plan nationally: | 31,594 members |