Blue Rx PDP Plus is a 4.0 Star Medicare Prescription Drug Plan Available in West Virginia
CMS gave this prescription drug plan a quality rating of 4.0 out of 5.0 stars (Above Average).
These are the areas of the plan that are important to compare and review:
- Premium & A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share.: The premium is the amount you will pay monthly. Plus, many plans have an annual deductible that must be met before An amount patients pay for their share of the cost of medical service or supply, like a doctor’s visit, hospital inpatient visit, or prescription drug. begins.
- Coverage Phases: Part D plans have an Once you have met your yearly deductible, you will pay a copayment or coinsurance for each covered drug until you reach the initial coverage limit. You will then enter your plan’s coverage gap (aka, “donut..., followed by a A period of time in which you pay higher cost-sharing for prescription drugs until you spend enough to qualify for catastrophic coverage., 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 Rx PDP Plus is a cost-sharing prescription drug plan (PDP). There are three distinct costs: monthly A premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , an annual deductible, and co-payments or co-insurance. The annual premium on this PDP is $1309.20 ($109.10 per month), and breaks down as follows:
Low-Income Subsidy ("Extra Help")
This plan does not qualify for Extra Help (Social Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium...) benefits.
This plan has a $480.00 deductible (annual).
For 2022, the maximum Part D deductible is $480. 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.
Here's What You Pay: 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 pick up 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 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 West Virginia Medicare Insurance Agent to get an exact quote for your situation.
Blue Rx PDP Plus is a Basic PDP. At a minimum, HM Health Insurance Company 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.
The Initial Coverage Limit
The Initial Coverage Limit is the same for all West Virginia plans, but it changes from year to year. If you enroll in Blue Rx PDP Plus you share the cost of all covered medications with HM Health Insurance Company. You each pay your share until $4430.00 (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 West Virginia.
The Part D Coverage Gap
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.
If you reach the ICL (most people don't), then you are responsible for 100% of your prescription costs until your Out-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. hit $7,050 (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 75% discount on your brand-name prescription drugs and your generic medications while you're in the gap. You get to the other side of the donut hole when you've spent $7,050, at which point you automatically qualify to receive catastrophic coverage from Medicare.
Additional Gap Coverage
Blue Rx PDP 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 West Virginia Medicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. 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 Rx PDP Plus prescription drug plan has A copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. (fixed dollar amount) and/or coinsurances (percentage) that you must pay when you pickup your medications. Here's the schedule for this plan:
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 A formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Medications not on a plan's formulary are generally not covered..
Medicare Part D Star Ratings
In this section we show you the quality rating for this plan. Each year the The Centers for Medicare & Medicaid Services (CMS) is the U.S. Federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Programs. (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 HM Health Insurance Company plan.
Contact HM Health Insurance Company
Here's the new member contact information for HM Health Insurance Company:
For assistance 24 hours a day, call 800-633-4227. TTY users should call 877-486-2048. If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... program on www.medicare.gov. For information about the SSA's Extra Help program, download the Understanding Extra Help guide.
Blue Rx PDP Plus can be used in conjunction with Original Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. (Parts A and B), and all Medicare supplement plans in West Virginia. It can also be used with West Virginia Medicare Advantage plans, but only if the Part C plan does not include Part D.
If you are entitled to Medicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. (enrolled or not) or currently enrolled in Medicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. you may join the Blue Rx PDP Plus prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Charleston, Huntington, Parkersburg, Morgantown, Wheeling, and all other towns and cities in West Virginia.