Tier 1 Generic drugs · 30-day supply
- Preferred retail
- $0 copay
- Standard retail
- $4 copay
● CMS 2027 plan record
HealthSpring Assurance Rx (PDP)
Standalone drug coverage
Medicare Prescription Drug Plan (PDP)
This plan covers prescription drugs. It is not Medicare Advantage and does not describe the member's hospital, medical, or supplemental coverage.
CMS-backed plan details
Drug plan at a glance
- Monthly premium
- $117.10 / month
- Part D deductible
- $700 / year
- Plan type
- Medicare Prescription Drug Plan
- Coverage area
- Upper Midwest and Northern Plains (Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming)
- Employer-only
- No
- Part D star rating
- Not published for this plan
Plan-specific costs
Prescription drug coverage
Annual Part D deductible $700
This is the plan-level amount in the 2027 CMS Landscape file. Check official documents for which drugs and tiers are subject to it.
Tier 2 Generic drugs · 30-day supply
- Preferred retail
- $3 copay
- Standard retail
- $12 copay
Tier 3 Brand and Generic drugs · 30-day supply
- Preferred retail
- 22% coinsurance
- Standard retail
- 23% coinsurance
Tier 4 Brand and Generic drugs · 30-day supply
- Preferred retail
- 35% coinsurance
- Standard retail
- 35% coinsurance
Tier 5 Brand and Generic drugs · 30-day supply
- Preferred retail
- 25% coinsurance
- Standard retail
- 25% coinsurance
Contract Year 2027
How this drug plan works
- 1Deductible
For this plan, the CMS-listed deductible is $700. What you pay and which tiers apply are controlled by the plan documents.
- 2Initial coverage
After any applicable deductible, you pay the plan's copay or coinsurance for covered drugs. Pharmacy type, supply length, and formulary tier can change the price.
- 3Catastrophic coverage
In 2027, member cost sharing for covered Part D drugs becomes $0 after qualifying out-of-pocket spending reaches $2,400.
- +Extra Help
People with limited income and resources may qualify for Extra Help with Part D premiums, deductibles, and prescription costs. Eligibility and assistance are separate from this plan's standard benefit.
Source trail
Official CMS, Contract Year 2027
Plan identity and benefits come from CMS PBP data. Benefits and drug cost sharing come from the approved annual PBP tabular extract and its CMS dictionary. Premiums and drug deductibles are cross-checked with the annual Landscape. Geography comes from annual PlanArea and PlanRegionArea records, including exact segments and partial-county or employer/group qualifiers. Quick-reference values should be confirmed in current official plan documents.
Plan context
Where S5715-043-000 fits
- Full CMS plan ID
S5715-043-000- Contract
S5715- Base plan code
S5715-043- Segment
000- Carrier
- Blue Cross and Blue Shield of IL, NM, OK, TX
- Plan type
- Medicare Prescription Drug Plan
- Service area
- IA, MN, MT, ND, NE, SD, WY (IA, MN, MT, ND, NE, SD, WY)
County/service-area foundation
CMS service-area entries
Service areas come from the annual CMS PlanArea and PlanRegionArea tables for this exact contract, plan, and segment. Partial-county and employer/group qualifiers remain part of the coverage area. Regional PPO county entries use the matching annual Landscape expansion of the CMS region.
- IA — all counties (CMS marker)
- MN — all counties (CMS marker)
- MT — all counties (CMS marker)
- ND — all counties (CMS marker)
- NE — all counties (CMS marker)
- SD — all counties (CMS marker)
- WY — all counties (CMS marker)
Is S5715-043-000 a Medicare Advantage plan?
No. S5715-043-000 is a standalone Medicare Part D prescription drug plan (PDP). It covers prescription drugs and does not replace Original Medicare or describe separate medical coverage.
What is the Part D deductible for S5715-043-000?
CMS lists a $700 annual Part D deductible for S5715-043-000. Confirm which drugs and tiers are subject to it in the plan's official documents.
Where can I find the S5715-043-000 formulary or drug list?
Use the plan carrier's current official formulary and search for each prescription by name, dose, and form. The CMS benefit data on this page describes tier costs but does not contain the plan's complete drug list.
Which pharmacies are in network for S5715-043-000?
Check the carrier's current pharmacy directory before filling a prescription. Preferred and standard network pharmacies can charge different amounts, and the CMS data on this page does not list individual pharmacies.
Who can enroll in S5715-043-000?
HealthSpring Assurance Rx (PDP) is not marked employer-only in CMS data. Its listed coverage area is Upper Midwest and Northern Plains (Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming); Medicare eligibility and the plan's enrollment rules still apply.
What is the monthly premium for S5715-043-000?
CMS lists a $117.10 monthly Part D premium for S5715-043-000. Extra Help or other assistance may change what an eligible member pays.
About this code
What S5715-043-000 identifies
S5715-043-000 is a Contract Year 2027 Medicare plan segment code. Searches written as S5715-043, S5715 043, or the compact full CMS ID S5715043000 refer to this plan or its base plan code.
Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.