2012 Medicare plans (Switch plan year)

Prescription Blue PDPSM benefit comparison

Need help choosing coverage?
This comparison summary will help you decide whether Prescription Blue Option A or B might work best for you.

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For Medicare-eligible Michigan residents

Summary of most frequently used benefits. You may also wish to download this benefit comparison (PDF 244KB).

Prescription Blue Option A Prescription Blue Option B
Monthly premium $59.60 Monthly premium $85.90
$270 deductible $0 deductible

Initial coverage limit: $2,930

You pay the following copayments and coinsurances at network pharmacies until your total prescription drug costs (paid by both you and your Plan) equal $4,700.

For up to a 31-day supply:
Tier 1 Preferred generic drugs $4
Tier 2 Preferred brand drugs $45
Tier 3 Non-preferred drugs $85
Tier 4 Non self-administered injectables 25%*
Tier 5 Specialty drugs 25%*

*of plan's approved amount

Initial coverage limit: $2,930

You pay the following copays and coinsurances at network pharmacies until your total prescription drug costs (paid by both you and your Plan) equal $4,700.

For up to a 31-day supply:
Tier 1 Preferred generic drugs $4
Tier 2 Preferred-brand drugs $45
Tier 3 Non-preferred drugs $85
Tier 4 Non self-administered injectables 25%*
Tier 5 Specialty drugs 30%*

*of plan's approved amount

Coverage gap
After your total prescription drug costs reach $2,930 until your total out-of-pocket costs reach $4,700, you pay 100% of the plan’s approved amount.

Coverage gap
After your total prescription drug costs reach $2,930 until your total out-of-pocket costs reach $4,700, you pay $4 for generic drugs and 100% for all other covered drugs.

Catastrophic coverage
After your yearly total out-of-pocket prescription drug costs (including deductibles, copays, coinsurance and 100% drug payments) reach $4,700 you pay the greater of:

Tier 1 $2.60 or 5% of the plan's approved amount
Tiers 2, 3, 4 and 5 $6.50 or 5% of the plan's approved amount

Catastrophic coverage
After your yearly total out-of-pocket prescription drug costs (including deductibles, copays, coinsurance and 100% drug payments) reach $4,700 you pay the greater of:

Tier 1 $2.60 or 5% of the plan's approved amount
Tiers 2, 3, 4 and 5 $6.50 or 5% of the plan's approved amount

Enroll today

An independent licensed Blues agent can help you select the plan option that best fits your needs, or you may enroll:

You don't need to be a member to get our help. If you have any questions or concerns, would like to find an agent or need assistance with enrolling, please call: 1-877-469-2583

H9572 S5584_W_12BCBSMAdvantageWebR2 CMS Approved 04262012

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to seventy-five (75) percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't even know it. For more information about the Extra Help program, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days per week. TTY users should call 1-877-486-2048.

Important information about these plans

Prescription Blue PDPSM is a stand-alone prescription drug plan with a Medicare contract.

Prescription Blue PDP is available to all Medicare beneficiaries who are Michigan residents entitled to receive services under Medicare Part A and/or enrolled in Part B. Premiums vary by county. You must continue to pay your Medicare Part B premium.

Limitations, copayments and restrictions may apply.

Our network includes approximately 2,300 Michigan retail pharmacies, of which 86 percent are network pharmacies. Nationwide, most chain pharmacies are in our network, as well as long-term care and home infusion pharmacies and Indian/Tribal/Urban (Indian Health Service) pharmacies.

In general, benefits are only available at contracted network pharmacies. Plan drugs may be covered in special circumstances, for instance, illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost sharing amount if you get your drugs at an out-of-network pharmacy. Quantity limitation and restrictions may apply. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Blue Cross Blue Shield of Michigan. For additional information on network pharmacies, please call Member Services at 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704. You may also write to: Blue Cross Blue Shield of Michigan, 600 E. Lafayette Blvd., Mail Code X435, Detroit, MI 48226.

If you decide to have your plan premium withheld from your Social Security check or deducted from your checking or savings account, it may take up to three months for the automatic deduction to begin. If your premium amount is currently withheld from your Social Security check or deducted from your checking or savings account and you wish to receive a monthly bill instead, the change may also take up to three months to become effective. During this time, you will be responsible for paying your premium.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on Jan. 1, 2013.

Medicare beneficiaries may enroll in Prescription Blue PDP through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. For more information, please contact Blue Cross Blue Shield of Michigan at 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704. To learn more about enrollment periods, please contact Member Services.