On this page we help consumers: Compare Blue Cross MedicareRx Plus, a 2020 Medicare Prescription Drug Plan (PDP) available in Texas for $147.20/month with a $0.00 deductible, with all Medicare Part D Plans in TX.
According to the Centers for Medicare and Medicaid Services (CMS), this plan's quality is Average, and rated it 3.5 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.
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 $1766.40 ($147.20 per month), and breaks down as follows:
This plan is not available to people receiving full 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 $435 per year in 2020) that must be paid before your prescription coverage assistance kicks in.
You Pay the Premium + Deductible + Copayments
Here's a rundown of your shared costs. Like all other types of insurance, you must pay your premium. The premium has nothing to do with how many prescriptions you have filled. If the plan has a deductible, you must pay one hundred percent of your prescription costs until you reach the amount of the deductible. When the deductible is met, then you pay the copayment amount at the pharmacy. All other costs are paid by the plan until you hit the donut hole (initial coverage limit)
What You Pay Could Be Different
Most people 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 Texas Medicare Insurance Agent.
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
The ICL is the same for all Texas plans, but it changes from year-to-year. If you enroll in Blue Cross MedicareRx Plus you share the cost of all covered medications with HISC - Blue Cross Blue Shield of IL, NM, OK, TX. 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 Texas.
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 people don't), then you are responsible for 100% of your prescription costs until your out-of-pocket costs hit $6,350 (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 $6,350, at which point you automatically qualify to receive catastrophic coverage from Medicare.
Additional Gap Coverage
Blue Cross MedicareRx Plus offers some additional assistance in the coverage gap. See the plan's Summary of Benefits for details. 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 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 HISC - Blue Cross Blue Shield of IL, NM, OK, TX 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 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.