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Cigna Healthcare Extra Rx (PDP) - S5617-266-000
$121.60
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.
$121.60
Monthly Premium
Louisiana 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 Louisiana 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) - S5617-266-000 Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $121.60 |
| 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 | $7.00 | $17.00 |
| Preferred mail order | $1.00 | $8.00 |
| Standard mail order | $7.00 | $17.00 |
| Tiers | Tier 1 Preferred Generic Drug | Tier 2 Generic Drug |
|---|---|---|
| Preferred retail | $2.00 | $16.00 |
| Standard retail | $14.00 | $34.00 |
| Preferred mail order | $2.00 | $16.00 |
| Standard mail order | $14.00 | $34.00 |
| Tiers | Tier 1 Preferred Generic Drug | Tier 2 Generic Drug |
|---|---|---|
| Preferred retail | $3.00 | $24.00 |
| Standard retail | $21.00 | $51.00 |
| Preferred mail order | $0.00 | $5.00 |
| Standard mail order | $21.00 | $51.00 |
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% | 45% | 31% |
| Standard retail | $7.00 | $17.00 | 21% | 45% | 31% |
| Preferred mail order | $1.00 | $8.00 | 18% | 45% | 31% |
| Standard mail order | $7.00 | $17.00 | 21% | 45% | 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% | 45% | N/A |
| Standard retail | $14.00 | $34.00 | 21% | 45% | N/A |
| Preferred mail order | $2.00 | $16.00 | 18% | 45% | N/A |
| Standard mail order | $14.00 | $34.00 | 21% | 45% | 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% | 45% | N/A |
| Standard retail | $21.00 | $51.00 | 21% | 45% | N/A |
| Preferred mail order | $0.00 | $5.00 | 18% | 45% | N/A |
| Standard mail order | $21.00 | $51.00 | 21% | 45% | N/A |
Plan Documents
| Links to plan documents |
Louisiana Counties Served
- Acadia
- Allen
- Ascension
- Assumption
- Avoyelles
- Beauregard
- Bienville
- Bossier
- Caddo
- Calcasieu
- Caldwell
- Cameron
- Catahoula
- Claiborne
- Concordia
- De Soto
- East Baton Rouge
- East Carroll
- East Feliciana
- Evangeline
- Franklin
- Grant
- Iberia
- Iberville
- Jackson
- Jefferson
- Jefferson Davis
- La Salle
- Lafayette
- Lafourche
- Lincoln
- Livingston
- Madison
- Miller
- Morehouse
- Natchitoches
- Orleans
- Ouachita
- Plaquemines
- Pointe Coupee
- Rapides
- Red River
- Richland
- Sabine
- Saint Bernard
- Saint Charles
- Saint Helena
- Saint James
- Saint Landry
- Saint Martin
- Saint Mary
- Saint Tammany
- St John The Baptist
- Tangipahoa
- Tensas
- Terrebonne
- Union
- Vermilion
- Vernon
- Washington
- Webster
- West Baton Rouge
- West Carroll
- West Feliciana
- Winn