2020 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | BlueCross Rx Value (PDP) by Blue Cross Blue Shield of South Carolina | ||||
State: | South Carolina | ||||
Plan ID: | S5953 - 001 - 0 Click to see other plans | ||||
Member Services: | 1-888-645-6025 TTY users 1-888-645-6023 | ||||
— 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 BlueCross Rx Value (PDP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $75.40 (see Plan Premium Details below) | ||||
Annual Deductible: | $195 (Tier 1 and 2 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): | $4,020 | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,508 drugs | Browse the BlueCross Rx Value (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: | $5.00 | $20.00 | $47.00 | 50% | 29% |
• Number of Drugs per Tier: | 157 | 989 | 456 | 1139 | 767 |
Plan Offers Mail Order? | Yes | ||||
Medicare Plan Pharmacy Numbers: | BIN: 004336 PCN: MEDDADV See BIN/PCNs for all plans | ||||
Plan Type (Reach): | Regional Plan | ||||
Number of Members enrolled in this plan in South Carolina: | 13,463 members (CMS Region 09) | ||||
Number of Members enrolled in this plan nationally: | 13,463 members | ||||
Plan’s Summary Star Rating: | 3.5 out of 5 Stars. | ||||
• Customer Service Rating: | 5 out of 5 Stars. | ||||
• Member Experience Rating: | 3 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 | ||
$75.40 | $75.40 | $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: | $51.60 | $57.60 | $63.50 | $69.50 |