2013 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | BlueRx Standard (PDP) by Medi-CareFirst BlueCross BlueShield | ||||
State: | Washington DC | ||||
Plan ID: | S5766 - 002 - 0 Click to see other plans | ||||
Member Services: | 1-800-693-1434 TTY users 1-800-693-0765 | ||||
— This plan information is for research purposes only. — Click here to see plans for the current plan year | |||||
Medicare Contact Information: | Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. TTY users 1-877-486-2048 or contact your local SHIP for assistance |
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Email a copy of the BlueRx Standard (PDP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $105.80 | ||||
Annual Deductible: | $250 | ||||
$0 Premium if LIS Benefits? | No, this plan does NOT qualify for the $0 Premium. | ||||
Annual Initial Coverage Limit (ICL): | $2,970 | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 5,220 drugs | Browse the BlueRx Standard (PDP) Formulary | |||
This plan has 5 drug tiers. See cost-sharing highlights below. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $5.00 | $16.00 | 20% | 37% | 25% |
• Number of Drugs per Tier: | 1259 | 929 | 207 | 2361 | 503 |
Plan Offers Mail Order? | Yes | ||||
Plan Type (Reach): | Regional Plan | ||||
Number of Members enrolled in this plan in your CMS Region: | 17,538 members (CMS Region 05) | ||||
Number of Members enrolled in this plan nationally: | 17,538 members | ||||
Plan’s Summary Star Rating: | 4.5 out of 5 Stars. | ||||
• Customer Service Rating: | 5 out of 5 Stars. | ||||
• Member Experience Rating: | 4 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 4 out of 5 Stars. |