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Cigna Healthcare Extra Rx (PDP) - S5617-252-000
$111.90
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.
$111.90
Monthly Premium
Virginia 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 Virginia 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) - S5617-252-000 Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $111.90 |
| 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 | $11.00 | $20.00 |
| Preferred mail order | $1.00 | $8.00 |
| Standard mail order | $11.00 | $20.00 |
| Tiers | Tier 1 Preferred Generic Drug | Tier 2 Generic Drug |
|---|---|---|
| Preferred retail | $2.00 | $16.00 |
| Standard retail | $22.00 | $40.00 |
| Preferred mail order | $2.00 | $16.00 |
| Standard mail order | $22.00 | $40.00 |
| Tiers | Tier 1 Preferred Generic Drug | Tier 2 Generic Drug |
|---|---|---|
| Preferred retail | $3.00 | $24.00 |
| Standard retail | $33.00 | $60.00 |
| Preferred mail order | $0.00 | $6.00 |
| Standard mail order | $33.00 | $60.00 |
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 | 18% | 50% | 31% |
| Standard retail | $11.00 | $20.00 | 22% | 50% | 31% |
| Preferred mail order | $1.00 | $8.00 | 18% | 50% | 31% |
| Standard mail order | $11.00 | $20.00 | 22% | 50% | 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 | 18% | 50% | N/A |
| Standard retail | $22.00 | $40.00 | 22% | 50% | N/A |
| Preferred mail order | $2.00 | $16.00 | 18% | 50% | N/A |
| Standard mail order | $22.00 | $40.00 | 22% | 50% | 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 | 18% | 50% | N/A |
| Standard retail | $33.00 | $60.00 | 22% | 50% | N/A |
| Preferred mail order | $0.00 | $6.00 | 18% | 50% | N/A |
| Standard mail order | $33.00 | $60.00 | 22% | 50% | N/A |
Plan Documents
| Links to plan documents |
Virginia Counties Served
- Accomack
- Albemarle
- Alexandria City
- Alleghany
- Amelia
- Amherst
- Appomattox
- Arlington
- Augusta
- Bath
- Bedford
- Bland
- Botetourt
- Bristol City
- Brunswick
- Buchanan
- Buckingham
- Buena Vista City
- Campbell
- Caroline
- Carroll
- Charles City
- Charlotte
- Charlottesville City
- Chesapeake City
- Chesterfield
- Clarke
- Colonial Heights City
- Covington City
- Craig
- Culpeper
- Cumberland
- Danville City
- Dickenson
- Dinwiddie
- Emporia City
- Essex
- Fairfax
- Fairfax City
- Falls Church City
- Fauquier
- Floyd
- Fluvanna
- Franklin
- Franklin City
- Frederick
- Fredericksburg City
- Galax City
- Giles
- Gloucester
- Goochland
- Grayson
- Greene
- Greensville
- Halifax
- Hampton City
- Hanover
- Harrisonburg City
- Henrico
- Henry
- Highland
- Hopewell City
- Isle Of Wight
- James City
- Jefferson
- King And Queen
- King George
- King William
- Lancaster
- Lee
- Lexington City
- Loudoun
- Louisa
- Lunenburg
- Lynchburg City
- Madison
- Manassas City
- Manassas Park City
- Martinsville City
- Mathews
- Mecklenburg
- Middlesex
- Montgomery
- Nelson
- New Kent
- Newport News City
- Norfolk City
- Northampton
- Northumberland
- Norton City
- Nottoway
- Orange
- Page
- Patrick
- Petersburg City
- Pittsylvania
- Poquoson City
- Portsmouth City
- Powhatan
- Prince Edward
- Prince George
- Prince William
- Pulaski
- Radford
- Rappahannock
- Richmond
- Richmond City
- Roanoke
- Roanoke City
- Rockbridge
- Rockingham
- Russell
- Salem
- Scott
- Shenandoah
- Smyth
- Southampton
- Spotsylvania
- Stafford
- Staunton City
- Suffolk City
- Surry
- Sussex
- Tazewell
- Virginia Beach City
- Warren
- Washington
- Waynesboro City
- Westmoreland
- Williamsburg City
- Winchester City
- Wise
- Wythe
- York