Your choice for drug coverage
Prescription drugs can be expensive. Blue MedicareRx is a Part D Prescription Drug Plan designed to help you manage your drug costs. Even if you don’t have drug costs now, this plan can protect you from the expense of prescription drugs you may need in the future.
Blue MedicareRx offers you:
- Protection from unexpected drug costs
- Coverage of preferred and non-preferred generic and brand-name drugs, as well as specialty drugs
- Access to a broad nationwide pharmacy network. Find participating pharmacies and search our drug lists (formularies) to see if your medications are covered.
Choose from three plan options
We offer three plan options — Essential, Value and Enhanced. Each option includes catastrophic coverage that helps protect against high drug costs after you have spent a certain amount on prescription drugs.
See below to compare our three options at each coverage stage.
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|
Blue MedicareRx Essential (PDP) |
Blue MedicareRx Value (PDP) |
Blue MedicareRx Enhanced (PDP) |
|
Monthly Plan premium - amount you pay |
$39.50 |
$36.20 |
$139.30 |
|
Annual deductible - amount you pay before initial coverage begins |
$0 on Tier 1 and Tier 2 drugs; $180 deductible on tiers 3-5 |
$445 |
$0 |
|
Initial coverage - amount you pay for a 30-day supply |
|
|
|
|
Tier 1 (Preferred Generic): |
$0 copay for retail cost sharing |
$0 copay for retail cost sharing |
$0 copay for retail cost sharing |
|
Tier 2 (Generic): |
$4 copay for retail cost sharing |
$4 copay for retail cost sharing |
$4 copay for retail cost sharing |
|
Tier 3 (Preferred Brand): |
18% copay for retail cost sharing |
25% copay for retail cost sharing |
18% coinsurance for retail cost sharing |
|
Tier 4 (Non-Preferred drug): |
40% coinsurance for retail cost sharing |
44% coinsurance for retail cost sharing |
40% coinsurance for retail cost sharing |
|
Tier 5 (Specialty): |
26% coinsurance |
25% coinsurance |
33% coinsurance |
|
Coverage gap - amount you pay for a 30-day supply after your total yearly covered prescription drug costs reach $4,430
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Generic drugs |
25% coinsurance |
25% coinsurance |
25% coinsurance |
|
Brand-name drugs |
No more than 25% coinsurance |
No more than 25% coinsurance |
No more than 25% coinsurance |
|
Catastrophic coverage - amount you pay for a 30-day supply after you have paid $7,050 in out-of-pocket prescription drug costs2 |
The greater of $3.95 copay for generic drugs $9.85 copay for all other covered drugs or 5% coinsurance |
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Pharmacies in the preferred network (nationwide) |
50,000 |
50,000 |
50,000 |
|
Mail Order (90-day supply) |
2.5x 30-day supply cost or the usual coinsurance |
3x 30-day supply cost or the usual coinsurance |
2.5x 30-day supply cost or the usual coinsurance |
1Your "total drug costs" means the total amount you have paid for covered drugs plus what the plan has paid for the calendar year. This does not include the plan premium you pay.
2Your "out-of-pocket costs" means the amount you have paid for covered drugs for the calendar year. This does not include the amount the plan has paid or the plan premium you pay.
- You may want to learn more about Medicare before choosing a plan if you are new to Medicare.
- Estimate your costs to help you decide which plan is right for you. Remember to compare all the benefits and value offered by each plan option, in addition to out-of-pocket costs.
Rates and coverage details
For plan rates and what's covered in each option, refer to the:
Use our pharmacy network for the greatest benefits
Once enrolled in Blue MedicareRx, you'll have access to a nationwide network of pharmacies that include major chains as well as neighborhood pharmacies. You may go to any of our network pharmacies.
In most cases, your prescriptions are covered only if they are filled at one of our network pharmacies. If you go to a pharmacy that is not in our network, you may have to pay more for your prescriptions and you may have to file a claim to be reimbursed. You will pay any difference between the non-network pharmacy's charge and the amount the plan allows. Some drugs may have quantity limits or be subject to step therapy or prior authorization requirements.
Letters and phone calls once you join our plan
When you join the Blue MedicareRx plan you may receive an occasional phone call from the plan. For example, if you have other prescription drug coverage, you may receive a call asking that you verify your other coverage so that Medicare can coordinate your benefits with your other plan coverage.
You will receive a letter from the plan shortly after your enrollment application is received if an agent helped with your enrollment. Its purpose is to make sure you are enrolled in the correct plan, describe how the plan works and answer any questions you may have.
If you have any questions about a phone call you receive from the plan, please call 1-877-853-7693 (TTY: 711), 8 a.m. to 8 p.m., daily, local time.
Medication Therapy Management (MTM) Program
If you meet certain requirements, you may be invited to participate in a program designed for your specific health and pharmacy needs. You may choose not to participate, but it is recommended that you take full advantage of this service if you are selected. Find out more about the program including who is eligible for MTM.