BlueCross Rx Value South Carolina Medicare Part D Plan S5953-001

BlueCross Rx Value  Medicare prescription drug plan for South Carolina SeniorsBlueCross Rx Value for South Carolina is a prescription drug plan (PDP) that's available to seniors in South Carolina on Medicare. The Centers for Medicare & Medicaid Services (CMS) evaluated this Medicare Part D plan's previous year performance and rated it 3.5 out of 5 stars (Average) for quality.

If you choose to enroll you will pay $32.40 per month (the premium). In addition to the premium there is a $360.00 annual deductible. You can find out more about the costs associated with this plan in the premium section of this page. You can check out the coverage information in the coverage secrion, or look at the copayments section to see your costs at the pharmacy.

Cost Details

This is a cost sharing based prescription drug plan (PDP). With the BlueCross Rx Value 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 $32.40 ($388.80 paid annually). It breaks down as follows:

Basic Premium:$32.40
Supplemental Premium:$0.00
Full Premium:$32.40

Low-Income Subsidy

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

Deductible

The annual deductible is $360.00. 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

You are required to pay your premium each month, even if you don't fill a prescription. Plus, you'll pay all of your prescription costs until the annual deductible amount has been paid (if any). You'll also pay the required copayment at your pharmacy when you have your prescriptions filled. These are your costs and the plan pays the rest.

What You Pay Could Be Different

There are two situations that can change your monthly premium. If your income is low and you are accepted into the Extra Help program administered by Social Security, your premium could be lower. It's also possible that your premium could be higher due to a late entry penalty. Be sure to speak with an authorized South Carolina Medicare Insurance Agent to get an exact quote for your situation.

Coverage Details

BlueCross Rx Value is a Basic Alternative PDP. At a minimum, Blue Cross Blue Shield of South Carolina 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

Confused about the initial coverage limit? Don't be, because it's straight forward. If you enroll in the BlueCross Rx Value PDP, you share the cost of your prescriptions with Blue Cross Blue Shield of South Carolina. You each pay your share until the amount spent at the pharmacy reaches $3310.00. That's the initial coverage limit in South Carolina for plan year 2016. After that you are not covered (coverage gap) until your actual out-of-pocket costs qualify you for catastrophic coverage. Keep reading, because you are entitled to automatic discounts.

Coverage Gap (aka, Donut Hole)

When you reach the coverage gap, commonly called the donut hole, you pay for your medications yourself. Most seniors never go into the coverage gap, but it is possible to hit it quickly if you have expensive long-term prescriptions.

If you reach the ICL (most seniors don't), then you are responsible for 100% of your prescription costs until your out-of-pocket costs hit $4,550 (excluding your monthly premiums and the amount paid by the plan). This is called the coverage gap or donut hole. The good news is that you get a 47.5% discount on brand-name prescription drugs and a 28% discount on generic drugs while you're in the gap. You get to the other side of the donut hole when you've spent $4,550, at which point you automatically qualify to receive catastrophic coverage from Medicare.

Additional Gap Coverage

BlueCross Rx Value 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 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 BlueCross Rx Value 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$2.00Preferred Generics
2$7.00Non-Preferred Generics
3$32.00Preferred 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

BlueCross Rx Value 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 (3.0 stars): Includes handling of member appeals.
  • Member experience with the plan's drug services (4.0 stars): Includes ratings of member satisfaction with the plan.
  • Drug safety and accuracy of drug pricing (3.0 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 BlueCross Rx Value 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.

About Blue Cross Blue Shield of South Carolina

For more information, download the Summary of Benefits (N/A), visit the Blue Cross Blue Shield of South Carolina website, or call Blue Cross Blue Shield of South Carolina at 800-930-2836.

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