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Cigna Healthcare Extra Rx (PDP) - S5617-265-000
$95.20
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.
$95.20
Monthly Premium
Mississippi 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 Mississippi 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) - S5617-265-000 Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $95.20 |
| 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 | $8.00 |
| Standard retail | $8.00 | $18.00 |
| Preferred mail order | $1.00 | $8.00 |
| Standard mail order | $8.00 | $18.00 |
| Tiers | Tier 1 Preferred Generic Drug | Tier 2 Generic Drug |
|---|---|---|
| Preferred retail | $2.00 | $16.00 |
| Standard retail | $16.00 | $36.00 |
| Preferred mail order | $2.00 | $16.00 |
| Standard mail order | $16.00 | $36.00 |
| Tiers | Tier 1 Preferred Generic Drug | Tier 2 Generic Drug |
|---|---|---|
| Preferred retail | $3.00 | $24.00 |
| Standard retail | $24.00 | $54.00 |
| Preferred mail order | $0.00 | $5.00 |
| Standard mail order | $24.00 | $54.00 |
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 | $8.00 | 19% | 47% | 31% |
| Standard retail | $8.00 | $18.00 | 22% | 47% | 31% |
| Preferred mail order | $1.00 | $8.00 | 19% | 47% | 31% |
| Standard mail order | $8.00 | $18.00 | 22% | 47% | 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 | $16.00 | 19% | 47% | N/A |
| Standard retail | $16.00 | $36.00 | 22% | 47% | N/A |
| Preferred mail order | $2.00 | $16.00 | 19% | 47% | N/A |
| Standard mail order | $16.00 | $36.00 | 22% | 47% | 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 | $24.00 | 19% | 47% | N/A |
| Standard retail | $24.00 | $54.00 | 22% | 47% | N/A |
| Preferred mail order | $0.00 | $5.00 | 19% | 47% | N/A |
| Standard mail order | $24.00 | $54.00 | 22% | 47% | N/A |
Plan Documents
| Links to plan documents |
Mississippi Counties Served
- Adams
- Alcorn
- Amite
- Attala
- Benton
- Bolivar
- Calhoun
- Carroll
- Chickasaw
- Choctaw
- Claiborne
- Clarke
- Clay
- Coahoma
- Copiah
- Covington
- Desoto
- Forrest
- Franklin
- George
- Greene
- Grenada
- Hancock
- Harrison
- Hinds
- Holmes
- Humphreys
- Issaquena
- Itawamba
- Jackson
- Jasper
- Jefferson
- Jefferson Davis
- Jones
- Kemper
- Lafayette
- Lamar
- Lauderdale
- Lawrence
- Leake
- Lee
- Leflore
- Lincoln
- Lowndes
- Madison
- Marion
- Marshall
- Monroe
- Montgomery
- Neshoba
- Newton
- Noxubee
- Oktibbeha
- Panola
- Pearl River
- Perry
- Pike
- Pontotoc
- Prentiss
- Quitman
- Rankin
- Scott
- Sharkey
- Simpson
- Smith
- Stone
- Sunflower
- Tallahatchie
- Tate
- Tippah
- Tishomingo
- Tunica
- Union
- Walthall
- Warren
- Washington
- Wayne
- Webster
- Wilkinson
- Winston
- Yalobusha
- Yazoo