Cigna Healthcare Extra Rx Part D Plan S5617-270 Details for Montana
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Cigna Healthcare Extra Rx is a prescription drug plan from Cigna Healthcare that's available to people enrolled in Original Medicare or a Medicare Advantage plan without Part D benefits.
This 2025 Medicare Part D plan has a $102.90 monthly premium, $175.00 annual deductible, $5,030 initial coverage limit, and a $8,000 out-of-pocket threshold. *This plan has an overall rating of 2.5 (Below Average) out of 5 stars.
See more Top Medicare Part D Plans in Montana.
| Part D Plan Basics | |
|---|---|
| Plan ID: | S5617-270 |
| Plan Type: | PDP |
| Plan Year: | 2025 |
| Premium: | $102.90/mo |
| Deductible: | $175.00/yr |
| Benefit Type: | Enhanced |
| Low Income Subsidy: | Yes |
| Availability: | Montana |
| Insured By: | Cigna Healthcare |
Prescription Drug Plan Premium
Although Cigna Healthcare Extra Rx 's monthly premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the premium details of this Cigna Healthcare plan.
| Basic Part D Premium: | $74.10 |
| Supplemental Part D Premium: | $28.80 |
| Total Part D Premium: | $102.90 |
| Low Income Premium Subsidy: | $50.63 |
| Low Income Premium Subsidy CMS Pays: | $50.60 |
| Low Income Subsidy Premium: | $52.30 |
The Social Security Extra Help page has more information about the Low-Income Subsidy (“Extra Help”) program.
Prescription Drug Plan Deductible
This plan's Medicare Part D annual deductible is $175.00. You must pay this amount at the pharmacy before Cigna Healthcare begins paying its share
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Cigna Healthcare Extra Rx has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Retail | Mail Order | Out of Network |
|---|---|---|---|
| Preferred Generic | $1.00 | $12.00 | $12.00 |
| Generic* | $10.00 | $20.00 | $20.00 |
| Preferred Brand* | 19.00% | 23.00% | 23.00% |
| Non-Preferred Drug | 50.00% | 50.00% | 50.00% |
| Specialty Tier | 31.00% | 31.00% | 31.00% |
| *Deductible does not apply. | |||
CMS Rating Marks for Plan Year 2025
Each year Medicare rates drug plans (Part D) in several major categories. These ratings are designed to help you understand the quality of care and service you can expect if you join this plan.
| CMS Measure | Star Rating |
|---|---|
| Overall Plan Rating | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
You can't judge a Part D plan on its monthly premium or annual deductible. You have to look at the overall cost of your prescriptions.
Contact Cigna Healthcare
| Plan Website: | Cigna Healthcare |
|---|---|
| Formulay Information: | Cigna Healthcare Formulary Information |
| Pharmacy Information: | Cigna Healthcare Pharmacy Information |
| Prospective Part D Members: | (800)735-1459 |
| Prospective Part D TTY Users: | (877)843-6493 |
If you qualify for Original Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program at www.medicare.gov.
Citations & References
- Cigna Healthcare, "http://www.cignamedicare.com", Last Accessed October 13, 2024
- Medicare.gov, "How to get prescription drug coverage", Last Accessed March 2, 2024
- Medicare.gov, "What Medicare Part D drug plans cover", Last Accessed March 1, 2024
- Medicare.gov, "Medicare costs at a glance", Last Accessed March 11, 2024
- Medicare.gov, "Help with drug costs", Last Accessed February 19, 2024
- CMS.gov, "Landscape Source Files", Last Accessed October 3, 2024
- CMS.gov, "Medicare Part C & D Performance", Last Accessed October 11, 2024
- CMS.gov, "Benefits Data", Last Accessed October 9, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.