On this page we help consumers: Compare BlueRx Enhanced Plus, a 2020 Medicare Prescription Drug Plan (PDP) available in Tennessee for $126.70/month with a $0.00 deductible, with all Medicare Part D Plans in TN.
According to the Centers for Medicare and Medicaid Services (CMS), this plan's quality is Average, and rated it 3.0 out of 5.0 stars.
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.
This is a cost sharing based prescription drug plan (PDP). With the BlueRx Enhanced Plus PDP you have several different costs, including the premium (monthly), a deductible (annual), and pharmacy co-pays and/or co-insurance.
The monthly premium is $126.70 ($1520.40 paid annually). It breaks down as follows:
This plan is not available to people receiving full Low Income Subsidy (LIS) benefits.
The annual deductible is $0.00.
A zero dollar ($0.00) deductible means you have first dollar coverage. Many Part D Plans have a deductible (up to $435 per year in 2020) that must be paid before your prescription coverage assistance kicks in.
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 Tennessee Medicare Insurance Agent to get an exact quote for your situation.
BlueRx Enhanced Plus is a Enhanced PDP. At a minimum, BlueRx (PDP) 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 Tennessee plans, but it changes from year-to-year. If you enroll in BlueRx Enhanced Plus you share the cost of all covered medications with BlueRx (PDP). You each pay your share until $4020.00 (retail spending) 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 Tennessee.
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 BlueRx Enhanced Plus 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 (75% off of both brand-name drugs and generics). You continue to pay this until your out-of-pocket costs reach $6,350. 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 BlueRx (PDP) pays.
Additional Gap Coverage
BlueRx Enhanced 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 Tennessee 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 BlueRx Enhanced 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)||$2.00 copay||$9.00 copay|
|2 (Generic)||$10.00 copay||$17.00 copay|
|3 (Preferred Brand)||$40.00 copay||$47.00 copay|
|4 (Non-Preferred Brand)||45%||50%|
|5 (Specialty Tier)||33%||33%|
IMPORTANT: In order to determine if this is the best PDP for you, it's critical that you look up 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 BlueRx (PDP) plan.
|2020 Overall Rating|
|Drug Plan Customer Service|
|Complaints and Changes in the Drug Plan|
|Member Experience with the Drug Plan|
|Drug Safety and Accuracy of Drug Pricing|
Contact BlueRx (PDP)
Here's the new member contact information for BlueRx (PDP):
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 BlueRx Enhanced Plus prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Nashville, Murfreesboro, Memphis, Knoxville, Chattanooga, Clarksville, Jackson, Johnson City, Franklin, Hendersonville, Kingsport, and all other towns and cities in Tennessee.