MedBlue Rx (PDP) South Carolina Medicare Part D Plan S5953-001

MedBlue Rx South Carolina Medicare Part D Plan S5953-001-SCMedBlue Rx for South Carolina is an approved Medicare Prescription Drug Plan (Part D Plan or PDP) for seniors and other beneficiaries on Medicare living in South Carolina. According to the Centers for Medicare and Medicaid Services (CMS), this plan's quality is "Average". Medicare rated it 3.5 out of 5.0 stars.

The monthly premium (payment) is $64.60. It features a $320.00 deductible. There are more cost related details on the premium page. You can check out the coverage information on the coverage page, or click on the copayments page to see your costs at the pharmacy.

This plan does not qualify for the government's $0 LIS premium.

Premium Details

Like all Medicare Part D plans sold in South Carolina, MedBlue Rx is a cost sharing based prescription drug plan (PDP). The MedBlue Rx PDP has three distinct costs: monthly premiums, an annual deductible, and co-payments.

The monthly premium is $64.60 ($775.20 paid annually), and the annual deductible is $320.00. For 2015, the maximum Part D deductible is $320. 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.

Be aware that you must continue to pay your monthly premium even when you are not using any medications. Also, it's important to plan ahead because you are responsible for one hundred percent of your prescription costs until the plan's deductible has been met. You also make the required copayment when you pickup your prescriptions. These are your share of the prescription drug costs. The plan pays the rest until you reach the coverage gap (aka, “donut hole”).

Most people in South Carolina on Medicare pay the standard premium. However, if you qualify for Extra Help with your Medicare Part D plan due to your income, your premium may be lower or cost you nothing at all. But, if you did not enroll in a Part D plan as soon as you were first eligible, Medicare can impose a penalty and your premium will be higher. To get an exact rate for your situation, contact a South Carolina Medicare Insurance Agent.

Coverage Details

MedBlue Rx for South Carolina seniors comes with an initial coverage limit (ICL) of $2,960. The deductible on this plan is $320.00 (annual). ICL is calculated based on the full retail cost of prescriptions, not what you or the plan pays. All Medicare prescription drug plans have co-pay requirements. The co-pay is the amount you pay when you fill your prescriptions. The co-payment schedule for this plan is on the co-pay page.

This PDP has a $320.00 deductible that you must pay at the pharmacy before the ICL phase of cost-sharing begins. The highest deductible allowed in 2015 is $320.

MedBlue Rx Initial Coverage Limit

It's important to understand the initial coverage limit (ICL) and how it applies to you in South Carolina. The ICL is where you share the cost of your prescriptions with the insurance company. You and the carrier (Blue Cross Blue Shield of South Carolina) each pay your share until you reach a total of $2,960 spent at the pharmacy on prescriptions. At that point you pay all costs yourself because you're in the coverage gap, as explained below.

Medicare Part D Coverage Gap (Donut Hole)

When you fall into the coverage gap, or donut hole as many people call it, you are basically uninsured and must pay for all of your prescription costs out-of-pocket. When you reach the coverage gap will all depend on your prescriptions. Most seniors never exceed the ICL and don't have to worry about it. If you are on a long-term medication that's costly, you could reach the donut hole very quickly.

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 Blue Cross Blue Shield of South Carolina pays.

Additional Gap Coverage with MedBlue Rx

Some plans offer additional gap coverage. Blue Cross Blue Shield of South Carolina does not offer additional coverage with the MedBlue Rx PDP in South Carolina. If you reached the coverage gap last year and were not able to afford your medications, be sure to check with your local South Carolina 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 MedBlue Rx prescription drug plan has copayments and/or coinsurances that you must pay when you pickup your medications. Here's the schedule for this plan:

Tier  Co-Pay AmountMedications in Tier
1$3.00390 Preferred Generics
2$11.001322 Non-Preferred Generics
3$44.00314 Preferred Brand Drugs
4$95.00547 Non-Preferred Brand Drugs
525%397 Specialty Drugs

The MedBlue Rx Medicare Part D plan uses Blue Cross Blue Shield of South Carolina formulary number 00015034, which covers 2970 generic and brand name drugs.

Compare Plans

Compare this plan with these South Carolina PDPs:


If you are entitled to Medicare Part A (enrolled or not) or currently enrolled in Medicare Part B you may join the MedBlue Rx prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Greenville, Anderson, Mauldin, Columbia, Charleston, Mount Pleasant, Rock Hill, Summerville, Sumter, Hilton Head and all other towns and cities in South Carolina.

This catalog is maintained by David Bynon and was last updated on 9/14/2015. CMS File Date: October 15, 2014.

About Blue Cross Blue Shield of South Carolina

For more information, download the Summary of Benefits Not Available, visit the Blue Cross Blue Shield of South Carolina website, or call Blue Cross Blue Shield of South Carolina at N/A.