|Medicare Prescription Drug Plan Benefit Details in Plain Text|
|The following Medicare Prescription Drug plan (PDP) benefits apply to the Blue MedicareRx Premier (PDP) (S5596 - 003) 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 the Blue MedicareRx Premier (PDP) prescription drug benefit details in chart format
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|The Blue MedicareRx Premier (PDP) has a monthly premium of $96.90. That is $1,162.80 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. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA).|
|Prescription Drug Coverage: Deductible, Cost-sharing, Formulary|
|This plan does NOT have a deductible for the prescription drug coverage. That means that you have first dollar coverage. Some plans have a deductible that must be paid (in full) prior to the prescription coverage assisting in your prescription costs (see cost-sharing below). The maximum deductible for 2011 is $310. This plan (Blue MedicareRx Premier (PDP)) has no deductible.|
|The following information is about the Blue MedicareRx Premier (PDP) formulary (or drug list). There are 4499 drugs on the Blue MedicareRx Premier (PDP) formulary. Click here to browse the Blue MedicareRx Premier (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. Since this plan has no deductible, your coverage (initial coverage phase) will start right away. 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 Premier (PDP)’s formulary is divided into 5 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: |
The Blue MedicareRx Premier (PDP)’s Initial Coverage Limit is $2,840. 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 7% of your generic drug prescription costs in the donut hole on your behalf. |
The brand-name drug manufacturer will pay 50% and your plan will pay an additional 0% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 50% discount. The 50% paid by the brand-name drug manufacturer is paid on your behalf and therefore counts toward your TrOOP (or True Out-of-Pocket) costs. The portion paid by your plan, does not count toward TrOOP. 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 Premier (PDP)) offers Coverage for Many Generics and Some Brands during the Coverage Gap phase. This means that many (65% to 100%) of the generic drugs and some (10% to 65%) of the brand-name drugs on the plans formulary (or drug list) will be covered through the coverage gap (or donut hole).