2018 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | AR Blue Cross - Medi-Pak Rx Premier (PDP) by ARKANSAS BLUE CROSS AND BLUE SHIELD | ||||
State: | Arkansas | ||||
Plan ID: | S5795 - 002 - 0 Click to see other plans | ||||
Member Services: | 1-866-390-3369 TTY users 1-888-844-5530 | ||||
— This plan information is for research purposes only. — Click here to see plans for the current plan year | |||||
— This plan was sanctioned in 2018 — Read more here... | |||||
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 AR Blue Cross - Medi-Pak Rx Premier (PDP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $112.80 (see Plan Premium Details below) | ||||
Annual Deductible: | $0 (Tier old 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): | $3,820 | ||||
Additional Gap Coverage? | Yes, some additional gap coverage. | ||||
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: | $2.00 | $8.00 | $40.00 | $90.00 | 33% |
Plan Offers Mail Order? | No | ||||
Plan Type (Reach): | Regional Plan | ||||
Number of Members enrolled in this plan in Arkansas: | 8,207 members (CMS Region 19) | ||||
Number of Members enrolled in this plan nationally: | 8,207 members | ||||
Plan’s Summary Star Rating: | 3.5 out of 5 Stars. | ||||
• Customer Service Rating: | 4 out of 5 Stars. | ||||
• Member Experience Rating: | 4 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 4 out of 5 Stars. | ||||
— Plan Premium Details — | |||||
The Monthly Premium is Split as Follows: ❔ | Total Premium | Part D Base Premium | Part D Supplemental Premium | ||
$112.80 | $-99.00 | $-99.00 | |||
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ | 100% Subsidy | 75% Subsidy | 50% Subsidy | 25% Subsidy | |
Monthly Part D Premium with LIS: | $-99.00 | $-99.00 | $-99.00 | $-99.00 |