A: Blue Medicare Rx coverage, which is sometimes referred to as Medicare Part D, is designed to help you by covering prescription drugs at
local pharmacies and through mail order.
Everyone with Medicare is eligible for this coverage, but the coverage is not mandatory. It is a voluntary program that you may choose to purchase each year.
Blue Medicare Rx coverage is insurance. Private companies, like Blue Cross and Blue Shield of North Carolina, provide the coverage.
A: If you have Medicare and have limited income and resources, you may qualify for special financial assistance to help you pay for your Blue Medicare Rx plan costs. The amount of assistance you qualify for will depend on your income and resources.
Beneficiaries interested in applying for extra help with Blue Medicare Rx Plan costs should call:
If you qualify for extra help with your Blue Medicare Rx Plan, your premium and drug costs will be lower. When you join BCBSNC, Medicare will tell us how much extra help you are getting. Then, we will let you know the amount you will pay.
A: Each plan provider will establish its own formulary, or list of prescription drugs, that it will cover. Although formularies must meet certain requirements set by Medicare, they still differ by plan.
Blue Medicare Rx coverage will include:
Generally speaking, Blue Medicare Rx coverage covers drugs that meet the following criteria:
Certain drugs, or classes of drugs, will not be covered because they are excluded by law, such as over the counter medicines like aspirin.
To learn which drugs are covered by BCBSNC’s Blue Medicare Rx Plans, search our drug list.
A: You will have the convenient option of using a mail-order pharmacy. You can purchase up to a 90-day supply through mail order, and your medications will be delivered directly to your home. Depending on your plan, there may be savings available to you if you use the mail option.
A: Congress designed Medicare prescription drug coverage on an annual enrollment cycle. This means that each year, you will have the option to re-enroll in your existing Medicare prescription drug coverage plan or change plans between October 15 and December 7 each year.
You may also have another opportunity during the year to switch plans, under limited circumstances. For example, if you move out of your plan’s service area, you’ll have an opportunity to choose another plan that serves your new area.
A: The fastest and easiest way to enroll is online, it takes just a few minutes! Or you can fill out a printed application and mail it to BCBSNC. You can print and fill out the application for the Blue Medicare Rx plan that you select, or you can enroll online. BCBSNC will enroll you in the Blue Medicare Rx plan and inform Medicare that you are enrolled. Once you become eligible for Medicare, you can join a Blue Medicare Rx plan any time between October 15 and December 7 each year. If you're eligible for Medicare, but you enroll after the enrollment period, you may be required to pay a late fee when you enroll in a Blue Medicare Rx plan. Ready to enroll?
A: You can join a Blue Medicare Rx Plan any time between October 15 and December 7 each year. If you enroll any time after December 31, you may have to pay a penalty. This penalty will not apply to Medicare beneficiaries who have equal or better prescription drug benefits through their employer or another plan, or for people who have not yet turned 65 when the enrollment period begins. To find out if your coverage is "equal or better," check with your employer or former employer.
A: The late penalty equals one percent of the premium amount for each month that enrollment is delayed. For example, if you delay enrollment in Blue Medicare Rx coverage for two years, you will pay an additional 24 percent on top of the premium each month.
A: The penalty was designed to encourage beneficiaries to enroll in Part D when they first become eligible. It helps hold down the overall costs of the drug program and is similar to the late penalty imposed for late enrollment in Medicare Part B.
A: Yes. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.
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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 10/01/2012.
Y0079_5875 CMS Approved 10012012