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2023 Medicare Prescription Drug Plan Benefit Details
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2023 Medicare Prescription Drug Plan Details
Medicare Plan Name:Humana Basic Rx Plan (PDP)
   by Humana
State:Rhode Island
Plan ID:S5884 - 102 - 0     Click to see other plans
Member Services:1-800-281-6918 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 Humana Basic Rx Plan (PDP) benefit details
— Medicare Plan Features —
Monthly Premium:$36.00 (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:3,190 drugsBrowse the Humana Basic Rx Plan (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 1Tier 2Tier 3Tier 4Tier 5
• Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:		$0.00$1.0019%40%25%
• Number of Drugs per
  Tier:		1456477521032614
Plan Offers Mail Order?Yes
Medicare Plan Pharmacy Numbers: BIN: 015581   PCN: 03200000   See BIN/PCNs for all plans
Plan Type (Reach):National Plan
Number of Members enrolled in this plan in Rhode Island:2,590 members
Number of Members enrolled in this plan in your CMS Region:58,984 members     (CMS Region 02)
Number of Members enrolled in this plan nationally:860,473 members
Plan’s Summary Star Rating: 3 out of 5 Stars.
• Customer Service Rating: 5 out of 5 Stars.
• Member Experience Rating: 3 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
$36.00$36.00$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$9.00$18.00$27.00




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    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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