Blue Cross MedicareRx Plus for Texas is a 2019 prescription drug plan (PDP) that's available to seniors on Medicare.
The Centers for Medicare & Medicaid Services (CMS) evaluated this Medicare Part D plan's previous year performance and rated it 3.0 out of 5 stars (Average) for quality.
These are the areas of the plan that are important to compare and review:
- Premium & Deductible: The premium is the amount you will pay monthly. Plud, many plans have an annual deductible that must be met before cost sharing begins.
- Coverage Phases: Part D plans have an initial coverage limit, followed by a coverage gap, and then catastropic coverage. Some plans offer some coverage in the gap.
- Co-pays & Co-insurance: If you have regular prescriptions, it's critical to verify that your drugs are covered and to know what you will pay at the pharmacy.
- CMS Ratings: Important measurements across 4 different areas that will help you understand how well this plan will care for you.
Blue Cross MedicareRx Plus is a cost sharing prescription drug plan (PDP). There are three distinct costs: monthly premiums, an annual deductible, and co-payments or co-insurance.
The annual premium on this PDP is $1681.20 ($140.10 per month), and breaks down as follows:
This plan is not available to people receiving low income subsidy (LIS) benefits.
There is a $0.00 annual deductible with this PDP.
A zero dollar ($0.00) deductible means you have first dollar coverage. Many Part D Plans have a deductible (up to $415 per year in 2019) that must be paid before your prescription coverage assistance kicks in.
You Pay the Premium + Deductible + Copayments
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”).
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 Texas Medicare Insurance Agent to get an exact quote for your situation.
Blue Cross MedicareRx Plus is a Enhanced PDP. At a minimum, HISC - Blue Cross Blue Shield of IL, NM, OK, TX 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 Blue Cross MedicareRx Plus PDP, you share the cost of your prescriptions with HISC - Blue Cross Blue Shield of IL, NM, OK, TX. You each pay your share until the amount spent at the pharmacy reaches $3820.00 (retail spending amount). That's the initial coverage limit in Texas for plan year 2019. 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 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 HISC - Blue Cross Blue Shield of IL, NM, OK, TX pays.
Additional Gap Coverage
Blue Cross MedicareRx Plus 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 Texas 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 Blue Cross MedicareRx Plus 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:
|1 (Preferred Generic)||$0.00 copay||$5.00 copay|
|2 (Generic)||$2.00 copay||$7.00 copay|
|3 (Preferred Brand)||$30.00 copay||$35.00 copay|
|4 (Non-Preferred Brand)||35%||45%|
|5 (Specialty Tier)||33%||33%|
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.
Medicare Part D Star Ratings
In this section we show you the quality rating for this plan. Each year the Centers for Medicare and Medicaid Services (CMS) rates prescription drug plans in four broad categories. We do not recommend joining a plan with an overall rating less than 3.0. The following marks will give you an idea of the level of care you will receive if you join this HISC - Blue Cross Blue Shield of IL, NM, OK, TX plan.
Contact HISC - Blue Cross Blue Shield of IL, NM, OK, TX
Here's the new member contact information for HISC - Blue Cross Blue Shield of IL, NM, OK, TX:
For assistance 24 hours a day, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048 or visit www.medicare.gov
If you are entitled to Medicare Part A (enrolled or not) or currently enrolled in Medicare Part B you may join the Blue Cross MedicareRx Plus prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Houston, San Antonio, Dallas, Austin, Fort Worth, El Paso, Arlington, Corpus Christi, Plano, Laredo, Lubbock, Garland, Irving, Amarillo, Grand Prairie, Brownsville, Pasadena, McKinney, Mesquite, McAllen, Killeen, Frisco, Waco, Carrollton, Denton, Midland, Abilene, Beaumont, Round Rock, Odessa, Wichita Falls, Tyler, Richardson, Lewisville, and all other towns and cities in Texas.
The Medicare Part D plan data on MedicareWire.com originates from CMS.gov Landscape Source files and is subject to change. The Centers for Medicare and Medicaid Services has neither reviewed nor endorsed the information on this site.
The benefit information provided on this page is a brief summary only, not a complete description. Limitations, co-payments, and restrictions may apply. For more information contact the plan directly at (877)213-1817 or (711)- for TTY users.
You must live in the service area and be enrolled in Medicare Part A and/or Medicare Part B in order to enroll in a Medicare Part D plan.
You must use network pharmacies to access drug benefit, except in non-routine circumstances. Restrictions may apply.
Benefits, formulary, pharmacy network, premium, and/or co-payments/co-insurance may change January 1, of each year.
This page presents an independent review of HISC - Blue Cross Blue Shield of IL, NM, OK, TX as a Medicare Part D plan insurance carrier in Texas. MedicareWire provides this information for consumer educational purposes. Our goal is to present information accurately and without bias, based on our interpretation of factual information about each carrier. MedicareWire is not a substitute for legal, health, or financial advice from a licensed professional.
On this page we help comsumers:
Compare Blue Cross MedicareRx Plus, a Medicare Part D Plan available in Texas for $140.10/month with a $0.00 annual deductible, with all 2019 Medicare Prescription Drug Plans in TX. Find the best PDP plan for the medications you take and start saving.
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This page is maintained by David Bynon and was last updated on .