Medicare Prescription Drug Plan Benefit Details in Plain Text|
|The following Medicare Prescription Drug plan (PDP) benefits apply to the Blue MedicareRx Standard (PDP) plan (S5596 - 046) in CMS Region 1, which includes all counties in ME NH.|
This plan is administered by ANTHEM INSURANCE COMPANIES, INC., a national plan provider. This means that the insurance carrier offers Medicare Part D plan in most every state. To switch to a different Medicare Prescription Drug plan or to change your location, click here.
Click here to see this information for the Blue MedicareRx Standard (PDP) plan in a chart format along with the plan enrollment options. We will also send a copy of the plan benefit details chart to your email account.|
|The Blue MedicareRx Standard (PDP) plan has a monthly premium of $32.80. That is $393.60 for 12 months. There are a few factors that can increase or decrease this premium. If you qualify for full or partial extra help, your premium will be lower. If you have a premium penalty, your premium will be higher.|
|Plan Membership and Plan Ratings|
|The Blue MedicareRx Standard (PDP) plan a new plan in county, therefore we do not yet have membership figures. The Centers for Medicare and Medicaid Services (CMS) has has given this plan carrier a summary rating of 2.50 stars. The detail CMS plan carrier ratings are as follows: a Customer Service Rating of 2 out of 5 stars , a Member Experience Rating of 2 out of 5 stars, and a Drug Cost Information Accuracy Rating of 2 out of 5 stars. |
|Prescription Drug Coverage: Deductible, Cost-sharing, Formulary|
|This plan has a $320.00 deductible. That means that you are 100% responsible for the first $320.00 in medication costs and after that is met, the Blue MedicareRx Standard (PDP) plan will share the costs of your medications with you. (See cost-sharing below). $320.00 is the maximum deductible for 2012. There are other plans with a lower deductible or even a $0 deductible. Click here to review plans with a $0 deductible.|
|The following information is about the Blue MedicareRx Standard (PDP) formulary (or drug list). There are 3212 drugs on the Blue MedicareRx Standard (PDP) formulary. the Blue MedicareRx Standard (PDP) does offer a mail order service. Click here to browse the Blue MedicareRx Standard (PDP) Formulary.|
|The Initial Coverage Phase (ICP) can be thought of as the cost-sharing phase of the plan. During this phase, you and the insurance company share your prescription costs. Once you have spent $320.00, your initial coverage phase will start. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The Blue MedicareRx Standard (PDP) plan’s formulary is divided into 6 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan is divided as follows: Tier 1 contains Preferred Generic Drugs drugs. The tier 1 co-payment is $4.00. Tier 2 contains Non-Preferred Generic Drugs drugs. The tier 2 co-payment is $7.00. Tier 3 contains Preferred Brand Drugs drugs. The tier 3 co-payment is $45.00. Tier 4 contains Preferred Brand Drugs drugs. The tier 4 co-payment is $90.00. Tier 5 contains Injectable Drugs drugs. The tier 5 co-insurance is 25% of the drug costs. Tier 6 contains Specialty Tier Drugs drugs. The tier 6 co-insurance is 25% of the drug costs. Click here to browse the Blue MedicareRx Standard (PDP) Formulary. The Blue MedicareRx Standard (PDP) plan’s Initial Coverage Limit is $2930. When this limit is reached, you exit the Initial Coverage Phase and enter the Coverage Gap (or Donut Hole).|
|The Coverage Gap, which is also known as the Donut (Doughnut) Hole is the phase of your Medicare Part D plan where
you are responsible for 100% of your medication costs. Healthcare Reform mandates that the insurance carrier pay 14% of your generic drug prescription costs in the donut hole on your behalf.
The brand-name drug pharmceutical company will pay 50% of the cost of your brand-name drugs pruchased in the donut hole on your behalf. Since the brand-name drug manufacturer pays on
your behalf, the portion that they pay counts toward your TrOOP (or True Out of Pocket) costs. Some Medicare Part D plans offer coverage during the Coverage Gap that is beyond the mandated discounts.
Any drug not covered by the plan’s Gap Coverage will still receive the discounts noted above -- even if the plan has "No Gap Coverage". This plan (Blue MedicareRx Standard (PDP)) offers No Coverage during the Coverage Gap phase.|