BlueMedicare Premier Rx is a 4.0 Star Medicare Part D Plan for Medicare Beneficiaries in Arkansas
The Centers for Medicare & Medicaid Services (CMS) evaluated this Medicare Part D plan's previous year performance and rated it 4.0 out of 5 stars (Above 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. Plus, 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.
BlueMedicare Premier Rx 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 full Low Income Subsidy (LIS) benefits.
This plan has a $0.00 deductible (annual).
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 2021) 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 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 Arkansas Medicare Insurance Agent to get an exact quote for your situation.
BlueMedicare Premier Rx is a Enhanced PDP. At a minimum, Arkansas Blue Cross and Blue Shield 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
It's important to understand the initial coverage limit (ICL) and how it applies to you in Arkansas. The ICL is where you share the cost of your prescriptions with the insurance company. You and Arkansas Blue Cross and Blue Shield each pay your share until you reach a total of $4130.00 (retail spending) spent at the pharmacy on prescriptions. At that point, you pay all costs yourself because you're in the coverage gap, as explained below.
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.
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
BlueMedicare Premier Rx 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 Arkansas 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 BlueMedicare Premier Rx 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:
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 Arkansas Blue Cross and Blue Shield plan.
Contact Arkansas Blue Cross and Blue Shield
Here's the new member contact information for Arkansas Blue Cross and Blue Shield:
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
This stand-alone Medicare Part D plan is compatible with Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), and all Arkansas Medigap plans. It's also compatible with Medicare Part C plans in Arkansas, so long as the plan does not include prescription drug coverage.
If you are entitled to Medicare Part A (enrolled or not) or currently enrolled in Medicare Part B you may join the BlueMedicare Premier Rx prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Little Rock, Fort Smith, Fayetteville, Springdale, Jonesboro, Rogers, Pine Bluff, Conway, and all other towns and cities in Arkansas.