BCBSIL – 2017 Medicare Part D Prescription Drug Plans


Blue Cross BlueShield of Illinois
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Blue MedicareRx Plans

Blue MedicareRx offers 3 plan designs: Basic, Value, and Plus. Below is an overview of each plan.

Blue MedicareRx Plans Comparison
Basic Value Plan Plus Plan
Monthly Premium*
$26.10
$65.50
$163.70
Deductible
$400 all Tiers
$400 for Tiers 3,4, and 5 only
$0
Copays
Preferred / Non-Preferred Network Preferred / Non-Preferred Network Preferred / Non-Preferred Network
Tier 1 – Preferred Generic Drugs
$0 / $5
$0 / $5
$0 / $5
Tier 2 – Non-Preferred Generic
$4 / $9
$10 / $15
$1 / $7
Tier 3 – Preferred Brand Drugs
16% / 21%
$42 / $47
$18 / $40
Tier 4 – Non-Preferred Brand
45% / 50%
$95 / $100
$70 / $95
Tier 5 – Specialty Drugs
25% / 25%
25% / 25%
33% / 33%
Coverage Levels
Initial Coverage
After you pay your yearly $400 deductible, you pay the copays above and BlueMedicare Rx pays for the remaining drug cost until the total combined yearly drug costs reach $3,700.
You pay the copays above and BlueMedicare Rx for tiers 1 and 2 and pay the $400 deductible for tiers 3-5 and subsequent copays until the total combined yearly drug costs reach $3,700.
You pay the copays above and BlueMedicare Rx pays for the remaining drug costs until the total combined yearly drug costs reach $3,700. There is no deductible with the Plus Plan.
Gap Coverage
Once you and your Blue MedicareRx Part D drug plan have spent $3,700 for covered drugs, you will be in the donut hole. You will also receive a discount on brand name drugs and generally pay no more than 45% for the plan’s costs for brand drugs and 58% of the plan’s costs for generic drugs until your yearly out-of-pocket drug costs reach $4,950. This annual out-of-pocket spending amount includes your yearly deductible, copayment, and coinsurance amounts.
Once you and your Blue MedicareRx Part D drug plan have spent $3,700 for covered drugs, you will be in the donut hole. You will also receive a discount on brand name drugs and generally pay no more than 45% for the plan’s costs for brand drugs and 58% of the plan’s costs for generic drugs until your yearly out-of-pocket drug costs reach $4,950. This annual out-of-pocket spending amount includes your yearly deductible, copayment, and coinsurance amounts.

Once you and your Blue MedicareRx Part D drug plan have spent $3,700 for covered drugs, you will continue to pay initial cost sharing on all formulary generics in Tiers 1, 2 and 5. You will also continue to pay initial cost sharing on some brands in Tiers 3, 4 and 5. On the remaining brand name drugs you will generally pay no more than 45% of the costs of the drugs.

The donut hole continues until your total out-of-pocket cost reaches $4,950. This annual out-of-pocket spending amount includes your copayment and coinsurance amounts.

After the Gap
When you spend more than $4,950 out-of-pocket, the coverage gap ends and your drug plan pays most of the costs of your covered drugs for the remainder of the year. You will then be responsible for whichever is greater:
Tier 1 – Preferred Generic Drugs: $3.30 copay or 5% coinsurance for your drug
Tier 2 – Non-Preferred Generic: $3.30 copay or 5% coinsurance for your drug
Tier 3 – Preferred Brand: $8.25 copay or 5% coinsurance for your drug
Tier 4 – Non-Preferred Brand: $8.25 copay or 5% coinsurance for your drug
Tier 5 – Specialty Drugs: 5% coinsurance for your drug
Summary of Benefits

Medicare Part D Eligibility

Before picking a plan, you need to be sure you are eligible for Blue MedicareRx.

To be eligible, you must:

  • Be entitled to receive services under Medicare Part A and/or enrolled in Part B
  • Reside in plan service area in the state of Illinois
  • Not be enrolled in any other Medicare Part D plan at the time

If you are enrolled in a Medicare Advantage HMO, PPO, or POS plan, you may only receive your Medicare prescription drug benefits through that Medicare Advantage plan.

You can also enroll if you have Original Medicare or have a Medigap policy in addition to a prescription drug plan.

You may not enroll in any Medicare-approved prescription drug plan unless you have a Medicare services account (MSA) or a private fee-for-service (PFFS) Medicare Advantage plan that does not provide Medicare prescription drug coverage.

If you are eligible and live where Blue MedicareRx is available, you should decide which enrollment period is right for you.

Enrollment Periods

Annual Enrollment Period*

  • Any time between October 15 and December 7th
  • Coverage begins on January 1st
  • Use this time to enroll in Blue MedicareRx for the first time or to switch plans

*Dates subject to change after January 1, 2017

Initial Enrollment Period

The Initial Enrollment Period (IEP) is the period of time when a Medicare beneficiary is first eligible to enroll in Blue MedicareRx. Instances of IEP include:

  • Eligibility due to turning age 65. This 7-month IEP includes the three months before a beneficiary’s 65th birthday, the birthday month and the three months after the birthday.
  • Eligibility based on being under age 65 and on disability or being diagnosed with End Stage Renal Disease. The IEP depends on the date the disability or treatments begin.

The effective date is generally the first day of the month after Blue MedicareRx receives the completed enrollment request.

Special Enrollment Period

There may be select circumstances when you can enroll outside of the initial and annual enrollment periods. Below is a list of some, but not all, of those circumstances:

  • A move outside of the plan’s approved service area
  • Entering or leaving a qualified institution, such as a nursing home
  • Enrolling in, or disenrolling, from a Medicare Advantage plan (medical and drug benefit)
  • Becoming eligible for low income subsidy assistance
  • Becoming enrolled in Medicare or Medicaid

To obtain more detailed information on a Special Enrollment Period, including enrollment and effective dates, please contact a Blue MedicareRx Product Specialist.

Late Enrollment Penalty

Part D Penalty – If you do not or did not join a Medicare drug plan when you first became eligible and didn’t have other creditable prescription drug coverage**, you may have to pay a late enrollment penalty of 1% for every month that you were eligible for Medicare but did not have creditable prescription drug coverage. This penalty would be added to your Part D plan premium, and the penalty amount could increase every year. You may also have to pay a penalty if you had a break in your Medicare drug coverage or other creditable drug coverage for at least 63 days in a row.

  • To avoid paying the Part D penalty: join a Medicare Part D plan when you first become eligible (called the Inital Enrollment Period*), and do not go more than 63 days in a row without a Medicare drug plan or other creditable coverage.

*The Initial Enrollment Period for Part B consists of the month of your 65th birthday, the three months before, and the three months after the month you turn 65.

**Creditable prescription drug coverage is coverage that is expected to pay on average at least as much as Medicare’s standard prescription drug coverage (eg. coverage from an employer or union).

Please visit the Social Security Administration website for more information.

After You Enroll

After Enrollment

After receiving your completed enrollment form, Blue MedicareRx will send you:

  • An acknowledgement letter within 10 days of receiving your enrollment form
  • After your enrollment has been approved, we’ll send you another letter no later than ten (10) calendar days from receipt of CMS confirmation of enrollment, or by the last day of the first month of enrollment, whichever occurs first
  • Approximately two weeks after receipt of your ID card, we’ll send your Welcome Kit. This package will include your Evidence of Coverage along with everything you’ll need to know about being a member of Blue MedicareRx
  • A confirmation letter with your member identification card and the date your coverage will be effective
  • Your Blue MedicareRx Welcome Kit, which includes your Evidence of Coverage and everything you’ll need to know about being a member

Evidence of Coverage

The evidence of coverage (EOC) is a detailed document that explains the plan rules associated with Blue MedicareRx. This document, together with your enrollment form, riders, coverage and the amendments that we may send to you, is our contract with you.

The EOC explains:

  • What is and is not covered by Blue MedicareRx
  • How to get your prescriptions filled
  • What you will have to pay for your prescriptions
  • Your rights and responsibilities

Evidence of Coverage: Basic Plan

Evidence of Coverage: Value Plan

Evidence of Coverage: Plus Plan

Medicare Part D Financial Help

People with limited incomes may qualify for extra help to pay for their prescription drug costs. If eligible, Medicare could pay for up to 100 percent of drug costs, including monthly prescription drug premiums, annual deductibles and copays/coinsurance. (An enrollee’s premium will generally be lower once he or she receives extra help from Medicare.)

Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t know it.

Best Available Evidence Policy

Get more information from the Centers for Medicare & Medicaid Services about the policy for applying for extra help and the documentation required

Low Income Subsidy Premium

The premiums listed do not include the amount you pay for your Medicare Part B premium.

Your level of extra help Monthly premium for Blue MedicareRx Value plan Monthly premium for Blue MedicareRx Plus Plan
100% $8.10 $65.00
75% $15.80 $72.70
50% $23.50 $80.40
25% $31.10 $88.20

To learn if you qualify for extra help, contact:

Medicare
1-800-MEDICARE (1-800-633-4227)
Hearing and speech impaired 1-877-486-2048
24 hours a day, 7 days a week

Social Security Administration
1-800-772-1213
Hearing or speech impaired 1-800-325-0778
7 a.m. – 7 p.m., Monday – Friday

Your local Medicaid office

Resources include savings and stocks, but not your home or car. Qualifications are established by the federal government and subject to change annually.

Medicare Supplement Plan Overview

Why You Need Medicare Supplement Insurance

Medicare is a federal program to help older Americans and some disabled Americans pay for the high cost of health care. However, Medicare was never intended to cover all your health care costs. So even if you’re covered by Medicare, you are still responsible for a large portion of your health care costs. Without Medicare Supplement insurance, your out-of-pocket costs could add up to more than $57,424 this year alone.

What Medicare Doesn’t Cover

Medicare does not cover all health care costs. Medicare coverage consists of Part A (which covers hospital and skilled nursing facility care), and Part B (which covers doctor bills and other medical expenses).

Even with Medicare Part A and Part B coverage, you’re responsible for some out-of-pocket expenses including:

  • Part A hospital deductible ($1,316)
  • Part B deductible ($183)
  • Copayments for hospital stays over 60 days
  • Care in a skilled nursing facility after 20 days
  • Twenty percent coinsurance for doctor bills and other medical expenses

By law, Medicare Supplement insurance is standardized into twelve plans (Plans A through L). That means Plan F from one company must include the same benefits as plan F from another company. While the benefits must be the same, each company’s rates, reputation, membership features and quality of service can vary. With Blue Cross and Blue Shield of Illinois, you don’t have to sacrifice comprehensive benefits or freedom-of-choice for affordability. Their Medicare Supplement plans provide substantial benefits at rates that can save you money over other plans.

Blue Cross Blue Shield of Illinois Member Benefits

All Blue Cross and Blue Shield of Illinois Medicare Supplement plans give you:

  • Guaranteed Acceptance with no health questions asked
  • Freedom to choose any doctors or specialists
  • Coverage with domestic travel (Plans F, HD-F, G, and N cover foreign travel)
  • Guaranteed renewability regardless of changes in your health
  • Coverage guaranteed to match Medicare’s cost increases year after year
  • Blue Extras Member Discount Program that include discounts on wellness products and services including vision, fitness clubs, weight management, complementary alternative medicine, hearing and more
  • No claim forms, in most cases

Medicare Supplement Basic Benefits

Basic benefits included in all plans include:

  • Hospitalization – Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.
  • Medical Expenses – Part B coinsurance (generally 20% of Medicare-approved expenses), or in the case of hospital outpatient department services under a prospective payment system, applicable copayments.
  • Blood – First three pints of blood each year.

*Plans K and L include benefits at different levels of cost sharing (see outline of coverage).

Premier Plans

  • Of all available standardized plans, Plans F and Plan G offer the most complete protection for uncovered Medicare Part B excess charges. These are the most popular plans because they also pay the Medicare Part A hospital deductible and copayments, skilled nursing facility copayment and foreign travel emergency care.
  • Plans F also covers the Medicare Part B deductible.

Budget-Conscious Plans

High Deductible Plan F, Plan K, Plan L and Plan N include cost-sharing features that allow you to save on premiums while still receiving dependable coverage.

  • High Deductible Plan F features a $2,200 annual deductible before plan benefits begin
  • Plan N features an office visit and emergency room copayment applicable to each visit
  • Plans K and Plan L feature cost sharing for covered services under Medicare Part A and Part B. Once your annual out-of-pocket expenses reach the required limit, the plan pays 100% of covered expenses for the remainder of the calendar year.

If you are seeking the most basic benefit plan with the lowest cost, BCBSIL offers Medicare Supplement Plan A. For more detailed explanations on all the available BCBSIL Medicare Supplement plans and benefits, you can Compare BCBSIL Medicare Supplement Plans.

BCBSIL Medicare Supplement Plans – Quick Comparison Table

Plans A F, HD-F* G K** L** N
Basic Benefits X X X X X X
Skilled Nursing Coinsurance X X 50% 75% X
Part A Deductible X X X 50% 75% X
Part B Deductible X
Part B Excess (100%) X X
Foreign Travel Emergency X X X
At Home Recovery
Annual Out-of-Pocket Cost $0 $0 $4,960 $2,480 $0

*Plan F also has an option called high deductible Plan F (HD-F). This high deductible plan pays the same benefits as Plan F after one has paid a calendar year $2,200 deductible. Benefits from high deductible Plan F will not begin until out-of-pocket expenses exceed $2,200. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare Part A and Medicare Part B deductibles, but do not include the plan’s separate foreign travel emergency deductible.

**Plans K and L provide for different cost-sharing than plans A-F. Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called “excess charges.” You will be responsible for paying excess charges.

Part B medical excess: Charges from your provider that exceed Medicare-approved amounts. Only Plan F, High Deductible Plan F, and Plan G cover these charges. For all other plans, you are responsible for paying excess charges. In no case can a provider charge more than 115% of the Medicare approved amount.

Skilled nursing coinsurance: Medicare pays the first 20 days of treatment in a skilled nursing facility, and an annually adjusted per diem for the 21st through 100th day. Plans with this benefit pay an additional annually adjusted per diem for the 21st through 100th day. You are responsible for all charges after the 100th day. In order to receive any Skilled Nursing Facility benefits, you must meet Medicare’s requirements:

  • You were admitted to a hospital for at least three days
  • You were admitted to a Medicare-approved skilled nursing facility within 30 days of leaving the hospital

Foreign travel emergency: Medically necessary emergency care services beginning during the first 60 days of each trip outside of the United States. All plans offering this benefit require you to pay a foreign travel emergency deductible and a percent of costs after the deductible is met.

Preventive care: Some annual physical and preventive tests and services administered or ordered by your doctor when not covered by Medicare.

Reduced Premium Medicare Select Option

Med-Select Options

Plan F, Plan G, Plan K, Plan L, and Plan N Med-Select options offer you the same solid benefits as the “standard” plans, but cost less. You save on premiums simply by agreeing to use any of the Med-Select participating hospitals for non-emergency elective admissions. If you do not use one of these hospitals for your non-emergency admissions, you pay the $1,316 Part A deductible. Med-Select is not an HMO. With Med-Select, you are fully covered for emergency care at any hospital, and you can choose your own doctors and specialists.

Med-Select is available in specific geographic areas only. You must live within a 30 mile radius of a Med-Select participating hospital.