2017 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | Prescription Blue Option B (PDP) by Blue Cross Blue Shield of Michigan | ||||
State: | Michigan | ||||
Plan ID: | S5584 - 002 - 0 Click to see other plans | ||||
Member Services: | 1-800-565-1770 TTY users 1-800-579-0235 | ||||
— 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 Prescription Blue Option B (PDP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $124.80 (see Plan Premium Details below) | ||||
Annual Deductible: | $0 (Tier excluded from the Deductible.) | ||||
$0 Premium if Full LIS Benefits? | No, this plan does NOT qualify for the $0 Premium. (See premiums for partial LIS subsidy below.) | ||||
Annual Initial Coverage Limit (ICL): | $3,700 | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,838 drugs | Browse the Prescription Blue Option B (PDP) Formulary | |||
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $3.00 | $7.00 | $45.00 | 45% | 33% |
• Number of Drugs per Tier: | 486 | 1584 | 368 | 783 | 617 |
Plan Offers Mail Order? | Yes | ||||
Plan Type (Reach): | Regional Plan | ||||
Number of Members enrolled in this plan in Michigan: | 27,980 members (CMS Region 13) | ||||
Number of Members enrolled in this plan nationally: | 27,980 members | ||||
Plan’s Summary Star Rating: | 5 out of 5 Stars. This plan qualifies for the 5-star rating Special Enrollment period. Read more. | ||||
• Customer Service Rating: | 5 out of 5 Stars. | ||||
• Member Experience Rating: | 5 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 5 out of 5 Stars. | ||||
— Plan Premium Details — | |||||
The Monthly Premium is Split as Follows: ❔ | Total Premium | Part D Base Premium | Part D Supplemental Premium | ||
$124.80 | $89.40 | $35.40 | |||
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ | 100% Subsidy | 75% Subsidy | 50% Subsidy | 25% Subsidy | |
Monthly Part D Premium with LIS: | $90.60 | $99.20 | $107.70 | $116.30 |