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HealthSpring Extra Rx (PDP) - S5617-378-000
$66.40
Monthly Premium
HealthSpring 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.
$66.40
Monthly Premium
Plan ID: S5617-378-000
Arizona 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 Arizona Medicare prescription drug plans like the one below and find a plan that offers the benefits you want at an affordable price.
HealthSpring Extra Rx (PDP) - S5617-378-000 Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $66.40 |
| Annual deductible | $615.00 |
| Preferred pharmacies? | Yes |
| Accepts Mail Order? | Yes |
| Star Rating | 2.5 out of 5 stars |
Prescription Drug Costs and Coverage
The HealthSpring 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 | $0.00 | $5.00 |
| Standard retail | $6.00 | $12.00 |
| Preferred mail order | $0.00 | $5.00 |
| Standard mail order | $6.00 | $12.00 |
| Tiers | Tier 1 Preferred Generic Drug | Tier 2 Generic Drug |
|---|---|---|
| Preferred retail | $0.00 | $10.00 |
| Standard retail | $12.00 | $24.00 |
| Preferred mail order | $0.00 | $10.00 |
| Standard mail order | $12.00 | $24.00 |
| Tiers | Tier 1 Preferred Generic Drug | Tier 2 Generic Drug |
|---|---|---|
| Preferred retail | $0.00 | $15.00 |
| Standard retail | $18.00 | $36.00 |
| Preferred mail order | $0.00 | $3.00 |
| Standard mail order | $18.00 | $36.00 |
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 | $0.00 | $5.00 | 17% | 31% | 25% |
| Standard retail | $6.00 | $12.00 | 20% | 32% | 25% |
| Preferred mail order | $0.00 | $5.00 | 17% | 31% | 25% |
| Standard mail order | $6.00 | $12.00 | 20% | 32% | 25% |
| 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 | $0.00 | $10.00 | 17% | 31% | N/A |
| Standard retail | $12.00 | $24.00 | 20% | 32% | N/A |
| Preferred mail order | $0.00 | $10.00 | 17% | 31% | N/A |
| Standard mail order | $12.00 | $24.00 | 20% | 32% | 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 | $0.00 | $15.00 | 17% | 31% | N/A |
| Standard retail | $18.00 | $36.00 | 20% | 32% | N/A |
| Preferred mail order | $0.00 | $3.00 | 17% | 31% | N/A |
| Standard mail order | $18.00 | $36.00 | 20% | 32% | N/A |
Plan Documents
| Links to plan documents |