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2024 Medicare Prescription Drug Plan Benefit Details for the Anthem MediBlue Rx Plus (PDP) - S5596-063
2024 Medicare Prescription Drug Plan Details
Medicare Plan Name:Anthem MediBlue Rx Plus (PDP)
   by Anthem MediBlue Rx (PDP)
State:Nevada
Plan ID:S5596 - 063 - 0     Click to see other plans
Member Services:1-833-285-4639 TTY users 711
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
Email a copy of the Anthem MediBlue Rx Plus (PDP) benefit details
— Medicare Plan Features —
Monthly Premium:$120.80 (see Plan Premium Details below)
Annual Deductible:$0
$0 Premium if LIS Benefits?No, this plan does NOT qualify for the $0 Premium. (See premium for LIS subsidy beneficiaries below.)
Annual Initial Coverage Limit (ICL):$5,030
Additional Gap Coverage?No additional gap coverage, only the Donut Hole Discount
Total Number of Formulary Drugs:3,249 drugsBrowse the Anthem MediBlue Rx Plus (PDP) Formulary
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers. 
Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less.
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
• Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:		$1.00$4.00$47.0050%33%
• Number of Drugs per
  Tier:		14346510791071491
Plan Offers Mail Order?Yes
Medicare Plan Pharmacy Numbers: BIN: 020115   PCN: IS   See BIN/PCNs for all plans
Plan Type (Reach):Regional Plan
Number of Members enrolled in this plan in Nevada:1,542 members     (CMS Region 29)
Number of Members enrolled in this plan nationally:84,006 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: 3 out of 5 Stars.
— Plan Premium Details —
The Monthly Premium is Split as Follows: ❔
Total
Premium		Part D Basic
Premium		Part D Supplemental
Premium
$120.80$90.80$30.00
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ $88.80




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