2025 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | Prescription Blue Premium (PDP) by Blue Cross Blue Shield of Michigan | ||||
State: | Michigan | ||||
Plan ID: | S5584 - 002 - 0 Click to see other plans | ||||
Member Services: | (800)565-1770 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 |
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Email a copy of the Prescription Blue Premium (PDP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $138.90 (see Plan Premium Details below) | ||||
Annual Deductible: | $0 (Tier excluded from the Deductible.) | ||||
$0 Premium if LIS Benefits? | No, this plan does NOT qualify for the $0 Premium. (See premium for LIS subsidy beneficiaries below.) | ||||
Drug Benefit Type ❔ | Enhanced Alternative (EA) | ||||
Total Number of Formulary Drugs: | 2,984 drugs | Browse the Prescription Blue Premium (PDP) Formulary | |||
Formulary Exception Tier: | Tier 4 | If your formulary exception request is approved, your drug will be placed on this tier. | |||
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 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $1.00 | $5.00 | $40.00 | 45% | 33% |
• Number of Drugs per Tier: | 84 | 586 | 860 | 771 | 683 |
Plan's Pharmacy Search: | http://www.bcbsm.com/pharmaciesmedicare | ||||
Plan Offers Mail Order? | Yes | ||||
Plan Type (Reach): | Regional Plan | ||||
Number of Members enrolled in this plan in Michigan: | 22,144 members (CMS Region 13) | ||||
Number of Members enrolled in this plan nationally: | 22,144 members | ||||
Plan’s Summary Star Rating: | 4 out of 5 Stars. | ||||
• Customer Service Rating: | 5 out of 5 Stars. | ||||
• Member Experience Rating: | 4 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 | ||
$138.90 | $76.70 | $62.20 | |||
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ | $112.30 |