2019 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | Basic Blue Rx Standard (PDP) by MII Life Insurance, Incorporated | ||||
State: | Pennsylvania | ||||
Plan ID: | S6986 - 003 - 0 Click to see other plans | ||||
Member Services: | 1-877-376-2185 TTY users 711 | ||||
— 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 Basic Blue Rx Standard (PDP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $27.40 (see Plan Premium Details below) | ||||
Annual Deductible: | $415 | ||||
$0 Premium if Full LIS Benefits? | Yes, this plan does qualify for the $0 Premium. (See premiums for partial LIS subsidy below.) | ||||
Annual Initial Coverage Limit (ICL): | $3,820 | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 2,993 drugs | Browse the Basic Blue Rx Standard (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: | $2.00 | $6.00 | 15% | 32% | 25% |
• Number of Drugs per Tier: | 287 | 473 | 903 | 721 | 609 |
Plan Offers Mail Order? | Yes | ||||
Plan Type (Reach): | Regional Plan | ||||
Number of Members enrolled in this plan in Pennsylvania: | 8,648 members | ||||
Number of Members enrolled in this plan in your CMS Region: | 10,653 members (CMS Region 06) | ||||
Number of Members enrolled in this plan nationally: | 18,451 members | ||||
Plan’s Summary Star Rating: | 3 out of 5 Stars. | ||||
• Customer Service Rating: | 5 out of 5 Stars. | ||||
• Member Experience Rating: | 2 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 3 out of 5 Stars. | ||||
— Plan Premium Details — | |||||
The Monthly Premium is Split as Follows: ❔ | Total Premium | Part D Base Premium | Part D Supplemental Premium | ||
$27.40 | $27.40 | $0.00 | |||
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ | 100% Subsidy | 75% Subsidy | 50% Subsidy | 25% Subsidy | |
Monthly Part D Premium with LIS: | $0.00 | $6.80 | $13.70 | $20.50 |