Blue Cross Part D Enrollment Application

Blue Cross Medicare Blue Rx 2008 Summary

Blue Cross Medicare Part D Medicare Drug Formulary

MedicareBlue Rx provides insurance coverage for prescription drugs. When you choose this type of insurance, you’re buying value and security because you’re protected against the unknown. Like other insurance, you pay a monthly premium and pay a share of the cost of your prescription drugs. Even if you don’t use many drugs now—you’ll have peace of mind knowing that as you age and may require prescription drugs to stay healthy, you have protection.

MedicareBlue Rx Option 1 Plan
With the lowest monthly premium $21.50, this plan is a basic prescription drug benefit that covers generic, brand name and specialty drugs.

• You pay a $265 annual deductible before the Plan pays anything.
• You pay 25% of the next $2,400 of total yearly drug costs for generics, preferred brand drugs and Specialty drugs. The Plan pays the rest.
• After total yearly drug costs reach $2,400, you pay 100% of your prescription drug costs until your yearly out-of-pocket drug costs reach $3,850.
• After that, you pay the greater of $2.15 co pay for generic drugs and $5.35 co pay for all others OR 5% coinsurance. 

MedicareBlue Rx Option 2 Plan
This plan premium is $35.90 with no deductible this plan will cover.

• There is NO deductible.
• For the first $2,400 of total yearly drug costs you pay $5 generic drugs, $20 brand drugs and 50% coinsurance for brand name drugs. 33% for specialty drugs. The Plan pays the rest.
• After total yearly drug costs reach $2,400 you pay 100% of your prescription drug costs until your yearly out-of-pocket drug costs reach $3,850.
• After that, you pay the greater of $2.15 co pay for generic drugs and $5.35 co pay for all others OR 5% coinsurance.

MedicareBlue Rx Option 3 Plan

This plan premium is $110.30 with no deductible and no gap in coverage, this plan will cover.

• There is NO deductible.
• You will pay 30% coinsurance until you have paid $3,850 in out-of-pocket drug costs. Plan pays 70%.
• There is no coverage gap.
• After your yearly out-of-pocket drug costs reach $3,850, after that, you pay the greater of $2.15 co pay for generic drugs and $5.35 co pay for all others OR 5% coinsurance.