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Cigna Healthcare Extra Rx (PDP) - S5617-349-000
$21.00
Monthly Premium
Cigna Healthcare Extra Rx (PDP) is a Medicare Part D Prescription Drug Plan offered by Cigna
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$21.00
Monthly Premium
Puerto Rico Medicare beneficiaries may want to consider reviewing their Medicare prescription drug coverage options, such as a standalone Part D prescription drug plan (PDP) or a Medicare Advantage (Medicare Part C) plan that includes drug coverage.
A Part D plan can be used alongside your Original Medicare (Part A and Part B) coverage. A Medicare Advantage plan that includes drug coverage combines your Part A, Part B and Part D benefits into a single plan
Learn more about Puerto Rico Medicare prescription drug plans like the one below and find a plan that offers the benefits you want at an affordable price.
Cigna Healthcare Extra Rx (PDP) - S5617-349-000 Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $21.00 |
| Annual deductible | $175.00 |
| Preferred pharmacies? | Yes |
| Accepts Mail Order? | Yes |
| Star Rating | 2.5 out of 5 stars |
Prescription Drug Costs and Coverage
The Cigna Healthcare Extra Rx (PDP) is a prescription drug plan which offers the following coverage:
Deductible Coverage Level
| Tiers | Tier 1 Preferred Generic Drug | Tier 2 Generic Drug |
|---|---|---|
| Preferred retail | $1.00 | $6.00 |
| Standard retail | $7.00 | $14.00 |
| Preferred mail order | $1.00 | $6.00 |
| Standard mail order | $7.00 | $14.00 |
| Tiers | Tier 1 Preferred Generic Drug | Tier 2 Generic Drug |
|---|---|---|
| Preferred retail | $2.00 | $12.00 |
| Standard retail | $14.00 | $28.00 |
| Preferred mail order | $2.00 | $12.00 |
| Standard mail order | $14.00 | $28.00 |
| Tiers | Tier 1 Preferred Generic Drug | Tier 2 Generic Drug |
|---|---|---|
| Preferred retail | $3.00 | $18.00 |
| Standard retail | $21.00 | $42.00 |
| Preferred mail order | $0.00 | $4.00 |
| Standard mail order | $21.00 | $42.00 |
Initial Coverage Level
| Tiers | Tier 1 Preferred Generic Drug | Tier 2 Generic Drug | Tier 3 Preferred Brand Drug | Tier 4 Non-Preferred Drug | Tier 5 Specialty Tier Drug |
|---|---|---|---|---|---|
| Preferred retail | $1.00 | $6.00 | 16% | 41% | 31% |
| Standard retail | $7.00 | $14.00 | 20% | 41% | 31% |
| Preferred mail order | $1.00 | $6.00 | 16% | 41% | 31% |
| Standard mail order | $7.00 | $14.00 | 20% | 41% | 31% |
| Tiers | Tier 1 Preferred Generic Drug | Tier 2 Generic Drug | Tier 3 Preferred Brand Drug | Tier 4 Non-Preferred Drug | Tier 5 Specialty Tier Drug |
|---|---|---|---|---|---|
| Preferred retail | $2.00 | $12.00 | 16% | 41% | N/A |
| Standard retail | $14.00 | $28.00 | 20% | 41% | N/A |
| Preferred mail order | $2.00 | $12.00 | 16% | 41% | N/A |
| Standard mail order | $14.00 | $28.00 | 20% | 41% | N/A |
| Tiers | Tier 1 Preferred Generic Drug | Tier 2 Generic Drug | Tier 3 Preferred Brand Drug | Tier 4 Non-Preferred Drug | Tier 5 Specialty Tier Drug |
|---|---|---|---|---|---|
| Preferred retail | $3.00 | $18.00 | 16% | 41% | N/A |
| Standard retail | $21.00 | $42.00 | 20% | 41% | N/A |
| Preferred mail order | $0.00 | $4.00 | 16% | 41% | N/A |
| Standard mail order | $21.00 | $42.00 | 20% | 41% | N/A |
Plan Documents
| Links to plan documents |
Puerto Rico Counties Served
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aibonito
- Anasco
- Arecibo
- Arroyo
- Barceloneta
- Barranquitas
- Bayamon
- Cabo Rojo
- Caguas
- Camuy
- Canovanas
- Carolina
- Catano
- Cayey
- Ceiba
- Ciales
- Cidra
- Coamo
- Comerio
- Corozal
- Culebra
- Dorado
- Fajardo
- Florida
- Guanica
- Guayama
- Guayanilla
- Guaynabo
- Gurabo
- Hatillo
- Hormigueros
- Humacao
- Isabela
- Jayuya
- Juana Diaz
- Juncos
- Lajas
- Lares
- Las Marias
- Las Piedras
- Loiza
- Luquillo
- Manati
- Maricao
- Maunabo
- Mayaguez
- Moca
- Morovis
- Naguabo
- Naranjito
- Orocovis
- Patillas
- Penuelas
- Ponce
- Quebradillas
- Rincon
- Rio Grande
- Sabana Grande
- Salinas
- San German
- San Juan
- San Lorenzo
- San Sebastian
- Santa Isabel
- Toa Alta
- Toa Baja
- Trujillo Alto
- Utuado
- Vega Alta
- Vega Baja
- Vieques
- Villalba
- Yabucoa
- Yauco