Blue Medicare Rx (PDP) - 2013 Plan Benefits
As with any Medicare Advantage plan, members may enroll only during specific times of the year. Details about when you may enroll in Medicare Advantage plans are available at medicare.gov or by calling 1-800-478-0583, 8 a.m. - 8 p.m., seven days a week. (TDD/TYY 1-800-922-3140).
Medicare Part D Plan Selector Tool
Learn about estimated costs and projected savings for your prescription drugs in the new plan year with the Plan Selector Tool.
We offer two Blue Medicare Rx (PDP) plans for you to choose from. Our Standard Plan meets Medicare's standard benefit requirements and has copayments for most drugs. Our Enhanced Plan exceeds Medicare's benefit requirements.
Why choose the Enhanced Plan?
- No deductible
- $4 and $30 copayments for most drugs
- Extensive list of covered drugs
- A large and accessible pharmacy network1
- Virtually no claims to file
- Our most popular plan2
| Plan Feature | Standard $61.00/month |
Enhanced 83.90/month |
|---|---|---|
| Drug list (Formulary) | The formulary covers many drugs eligible for coverage under Medicare Part D | The formulary covers many drugs eligible for coverage under Medicare Part D |
| Annual Deductible | $150 deductible | No deductible |
| Tier 1 Preferred generic | $4 | $4 |
| Tier 2 Non-preferred generic | $25 | $20 |
| Tier 3 Preferred brand copayment | $45 | $30 |
| Tier 4 Non-preferred brand copayment | $95 | $70 |
| Tier 5 Specialty | 29% coinsurance | 33% coinsurance |
| Phase 1: Annual deductible |
You pay $150 annual deductible. |
You pay $0 You pay no annual deductible. |
| Phase 2: Initial coverage |
You + Plan = $2,970 You pay the copayment or coinsurance for your drugs, and the plan pays the remainder until total drug costs reach $2,970. |
|
| Phase 3: Coverage gap |
You pay 79% of your generic drug costs and receive a discount for brand-name drugs. You pay these amounts until your yearly out-of-pocket drug costs (not including premium) equal $4,750. |
You pay $4 copayment for all Preferred generics and 79% of all other generic drug costs. You receive a discount on brand-name drugs. You pay these amounts until your yearly out-of-pocket drug costs (not including premium) equal $4,750. |
| Phase 4: Catastrophic coverage |
You pay 5% After you reach $4,750 in out-of-pocket costs, the plan pays the majority of the drug costs until the end of the year. You pay the greater of $2.65 for generic, $6.60 for brand name or 5% of the total drug cost. |
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Additional Information
We also provide an overview of the benefits covered by both plans, along with a comprehensive explanation of those benefits and a list of the exclusions and limitations for each plan.
Product Brochure - Contains important information and a summary of benefits
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call:
- 1-800-MEDICARE (1-800-633-4227) – TTY users should call 1-877-486-2048, 24 hours a day, 7 days a week
- Social Security at 1-800-772-1213, 7 a.m. – 7 p.m., Monday – Friday (TTY users should call 1-800-325-0778)
- Your state Medicaid office
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.
To view PDF documents you need Adobe Acrobat Reader.
1 Beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply.
2 BCBSNC internal data, 2012
BCBSNC is a prescription drug plan sponsor with a Medicare contract. Prescription drug coverage is not sold as a benefit of any Medicare supplement plan.
The benefit information provided is a brief summary, but not a complete description of benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; for more information contact the plan.
This tool provides useful information to help you review plans based on your current drug needs. The drug costs displayed are estimates and may vary based on the specific quantity, strength and/or dosage of the medication, the order in which you purchase your prescriptions, and the pharmacy you use. But it also is important to look beyond your current needs at the insurance value of Blue Medicare Rx coverage. Enrolling now gives you peace of mind because the coverage will be there even if your drug needs become more significant in the future. And any time you spend out-of-pocket more than $4,750 in a year, Medicare will pay almost all of your remaining drug costs.
For Medicare Advantage and Part D plans, benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. For Medicare supplement plans, the changes occur on June 1 of each year. Please contact BCBSNC for details.
BCBSNC is a Medicare Advantage organization with a Medicare contract. BCBSNC is a Medicare-approved Part D sponsor. BCBSNC does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability or geographic location within the service area. All BCBSNC items and services are available to all eligible beneficiaries in the service area. Limitations, copayments, and restrictions may apply. You must be entitled to Medicare Part A and enrolled in Medicare Part B and must reside in CMS-approved service area. You must continue to pay your Medicare Part B premium.
If you would like Medicare Advantage or Part D documents in a different language or format, or your coverage has ended and you need proof of coverage or a Certification of Health Insurance Coverage, you can call us 7 days a week, 8 a.m. to 8 p.m.
® Mark of the Blue Cross and Blue Shield Association. SM Mark of Blue Cross and Blue Shield of North Carolina.
The information on this page is current as of 12/10/2012.
Y0079_6085 CMS Approved 12112012
© , Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.