2019 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | Blue Cross MedicareRx Plus (PDP) by HISC - Blue Cross Blue Shield of Illinois | ||||
State: | Illinois | ||||
Plan ID: | S5715 - 002 - 0 Click to see other plans | ||||
Member Services: | 1-888-285-2249 TTY users 1-888-285-2252 | ||||
— 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 Blue Cross MedicareRx Plus (PDP) benefit details
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— Medicare Plan Features — | |||||
Monthly Premium: | $130.60 (see Plan Premium Details below) | ||||
Annual Deductible: | $0 | ||||
$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? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,603 drugs | Browse the Blue Cross MedicareRx Plus (PDP) Formulary | |||
This plan has 5 drug tiers.
See cost-sharing for all pharmacies and tiers.
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Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $0.00 | $2.00 | $30.00 | 35% | 33% |
• Number of Drugs per Tier: | 148 | 1021 | 1054 | 665 | 715 |
Plan Offers Mail Order? | Yes | ||||
Plan Type (Reach): | Regional Plan | ||||
Number of Members enrolled in this plan in Illinois: | 18,207 members (CMS Region 17) | ||||
Number of Members enrolled in this plan nationally: | 33,224 members | ||||
Plan’s Summary Star Rating: | 3 out of 5 Stars. | ||||
• Customer Service Rating: | 4 out of 5 Stars. | ||||
• Member Experience Rating: | 3 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 2 out of 5 Stars. | ||||
— Plan Premium Details — | |||||
The Monthly Premium is Split as Follows: ❔ | Total Premium | Part D Base Premium | Part D Supplemental Premium | ||
$130.60 | $78.10 | $52.50 | |||
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ | 100% Subsidy | 75% Subsidy | 50% Subsidy | 25% Subsidy | |
Monthly Part D Premium with LIS: | $103.20 | $110.10 | $116.90 | $123.80 |