AR Blue Cross - Medi-Pak Rx Basic Arkansas Medicare Part D Plan S5795-003

AR Blue Cross - Medi-Pak Rx Basic  Medicare prescription drug plan for Arkansas SeniorsAR Blue Cross - Medi-Pak Rx Basic for Arkansas is a Medicare Part D prescription drug plan. It's approved by the Centers for Medicare and Medcaid Services (CMS) for people in Arkansas with Medicare benefits. CMS gave this plan a quality rating of 3.5 out of 5.0 stars (Average).

If you enroll in this plan you'll pay the $40.10 monthly premium, and there's a $300.00 annual deductible before cost sharing begins. For more information about the costs, refer to the premium section on this page. You also have co-payments when you pickup your prescriptions at the pharmacy. Be sure to look at the coverage section to make sure it fits your needs.

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Cost Details

This is a cost sharing based prescription drug plan (PDP). With the AR Blue Cross - Medi-Pak Rx Basic PDP you have several different costs, including the premium (monthly), a deductible (annual), and pharmacy co-pays and/or co-insurance.

Premium

The monthly premium is $40.10 ($481.20 paid annually). It breaks down as follows:

Basic Premium:$40.10
Supplemental Premium:$0.00
Full Premium:$40.10

Low-Income Subsidy

This plan is not available to people receiving low income subsidy (LIS) benefits.

Deductible

The annual deductible is $300.00. For 2016, the maximum Part D deductible is $360. A plan with the maximum deductible does not necessarily mean that it is more expensive than a plan with a lower deductible or no deductible at all. You need to consider all costs.

You Pay the Premium + Deductible + Copayments

Here's a rundown of your shared costs. Like all other types of insurance, you must pay your premium. The premium has nothing to do with how many prescriptions you have filled. If the plan has a deductible, you must pay one hundred percent of your prescription costs until you reach the amount of the deductible. When the deductible is met, then you pay the copayment amount at the pharmacy. All other costs are paid by the plan until you hit the donut hole (initial coverage limit)

What You Pay Could Be Different

There are two conditions that could affect how much you pay for this plan. If you qualify for the Social Security Extra Help program your premium will generally be lower. Also, if you enrolled late the Centers for Medicare and Medicaid Service may impose a premium penalty. Contact your local Arkansas Medicare Insurance Agent to get an exact quote for your situation.

Coverage Details

AR Blue Cross - Medi-Pak Rx Basic is a Basic Alternative PDP. At a minimum, ARKANSAS BLUE CROSS AND BLUE SHIELD must offer a "standard benefit" package mandated by law. The standard benefit includes an annual deductible and a gap in coverage, aka, donut hole. Carriers may also offer plans that:

  • are actuarially equivalent to the standard benefit; or
  • are enhanced, offering benefits in addition to the standard benefit.

Typically, enhanced plans offer additional coverage during the coverage gap. If you fell into the donut hole last year, shop enhanced plans.

Initial Coverage Limit

The ICL is the same for all Arkansas plans, but it changes from year-to-year. If you enroll in AR Blue Cross - Medi-Pak Rx Basic you share the cost of all covered medications with ARKANSAS BLUE CROSS AND BLUE SHIELD. You each pay your share until $3310.00 has been spent at the pharmacy. If you reach that level of spending on your prescriptions then you fall into the dreaded coverage gap and you are responsible for all costs. Fortunately, automatic discounts kick in to help you until you qualify for Medicare's catastrophic coverage in Arkansas.

Coverage Gap (aka, Donut Hole)

The coverage gap, or donut hole, as it is often called, is the coverage phase where you no longer receive assistance from the plan. In other words, you pay for your prescriptions out-of-pocket. How quickly you reach the coverage gap with AR Blue Cross - Medi-Pak Rx Basic all depends on your prescriptions. Most seniors never fall into the donut hole.

When you're in the donut hole you pay all of the costs for your medications, but at a discounted rate (47.5% off of brand-name drugs and 28% off generics). You continue to pay this until your out-of-pocket costs reach $4,550. At this point Medicare takes over by giving you catastrophic coverage. The $4,550 out-of-pocket figure does not include your monthly premiums or what ARKANSAS BLUE CROSS AND BLUE SHIELD pays.

Additional Gap Coverage

AR Blue Cross - Medi-Pak Rx Basic does not offer additional assistance in the coverage gap. If you reached the coverage gap last year and were not able to afford your medications, be sure to check with your local Arkansas Medicaid office. You may qualify for additional assistance. The Social Security Administration's Extra Help program is another opportunity for seniors on Medicare who are not able to afford their prescriptions.

Copayment & Coinsurance Details

In addition to the monthly premium and annual deductible, the AR Blue Cross - Medi-Pak Rx Basic prescription drug plan has copayments (fixed dollar amount) and/or coinsurances (percentage) that you must pay when you pickup your medications. Here's the schedule for this plan:

Tier You PayMedications in Tier
1$4.00Preferred Generics
2$15.00Non-Preferred Generics
3$42.00Preferred Brand Drugs
4$95.00Non-Preferred Brand Drugs
525%Specialty Drugs

IMPORTANT: In order to determine if this is the best PDP for you, it's critical that you lookup your prescriptions in the plan's formulary.

Quality Rating

AR Blue Cross - Medi-Pak Rx Basic has an overall rating of 3.5 out of 5 stars. This summary rating was assigned by the Centers for Medicare and Medicaid Services (CMS) based on the plan's previous year performance. It provides shoppers with an overall score on the drug plan's quality and performance across 3 broad categories:

  • Drug plan customer service ( stars): Includes handling of member appeals.
  • Member experience with the plan's drug services ( stars): Includes ratings of member satisfaction with the plan.
  • Drug safety and accuracy of drug pricing ( stars): Includes how accurate the plan's pricing information is and how often members with certain medical conditions are prescribed drugs in a way that is considered safer and clinically recommended for their condition.

CMS gathers quality information from several sources, including member surveys, reviews of billing and other information that plans submit to Medicare, and other monitoring activities.

Availability

If you are entitled to Medicare Part A (enrolled or not) or currently enrolled in Medicare Part B you may join the AR Blue Cross - Medi-Pak Rx Basic prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Little Rock, Fort Smith, Fayetteville, Springdale, Jonesboro, Rogers, Pine Bluff, Conway, and all other towns and cities in Arkansas.

About ARKANSAS BLUE CROSS AND BLUE SHIELD

For more information, download the Summary of Benefits (N/A), visit the ARKANSAS BLUE CROSS AND BLUE SHIELD website, or call ARKANSAS BLUE CROSS AND BLUE SHIELD at 800-392-2583.

This PDP information is maintained by and was last updated on .