Anthem Blue MedicareRx Standard is a 2018 prescription drug plan (PDP) that's available to people in Ohio with Medicare benefits.
There are five components of every plan that should be evaluated before making an enrollment decision:
- Premium & Deductible: The premium is the amount you pay to be in the plan. This is the monthly cost of membership. In addition, plans may have an annual deductible. This is an amount that you pay towards your prescription costs before cost sharing begins.
- Co-pays & Co-insurance: This is where many people pay more than they should. Prescription co-payments (what you pay at the pharmacy) vary widely based on the formulary tier your drug is in. It's critical to verify that your medications are covered at the lowest tier possible.
- Coverage Phases: All Medicare Part D plans have an initial coverage phase, followed by a coverage gap phase, followed by a catastrophic coverage phase. The phase you're in will largely depend on the cost of your prescriptions. Some plans offer additional coverage in the gap phase. If you have costly medications, look for a plan with additional gap coverage.
- Medication Cost: One of the most challenging aspects of the Medicare Part D program is finding your prescription at the best price. It has as much to do with the pharmacy you use as it does the plan itself. This is because plans have preferred pharmacies and pharmacies have different contracts with pharmaceutical manufactures. Here's a secret, use our friends at GoodRx.com to find your prescription at the best price in your town.
- 5-Star Ratings: Critical measurements, by Medicare, will help you see how well this plan will care for you.
Detailed Cost Information
Anthem Blue MedicareRx Standard is a cost sharing plan. There are three costs: monthly premiums, an annual deductible, and co-payments or co-insurance.
The annual premium is $872.40 ($72.70 per month), and breaks down like this:
You can't join the Anthem Blue MedicareRx Standard plan if you have low income subsidy (LIS) benefits.
There is a $405.00 annual deductible with this PDP.
The Part D deductible is capped at $405 (2018 level). A plan with the maximum deductible is not always more expensive than a similar plan with a lower deductible. You must factor in all costs (premium, deductible, co-pay and pharmacy price).
Your Out-of-Pocket Costs: Premium + Deductible + Co-pay
You are required to pay your premium each month, even if you don't fill a prescription. Plus, you'll pay all of your prescription costs until the annual deductible amount has been paid (if any). You'll also pay the required copayment at your pharmacy when you have your prescriptions filled. These are your costs and the plan pays the rest.
Your Costs May Be Different
There are two situations that change change what you pay. If you're accepted into the Extra Help program, administered by the Social Security Administration, your premium could be lower. It's also possible that your premium could be higher if you have a late entry penalty because you did not enroll when first eligible.
Details of Plan Coverage
Anthem Blue MedicareRx Standard is a Basic Alternative plan. By law, Blue MedicareRx is required to offer a standard benefit package. The standard benefit has an annual deductible, an initial coverage limit, a gap in coverage (donut hole), and a catastrophic coverage phase. Insurance carriers have the option to offer plans that:
- are an actuarial equivalent to the standard benefit; or
- provide enhanced benefits, as compared to the standard benefit.
Most enhanced plans provide additional coverage in the coverage gap phase. If your medications are costly, shop and compare enhanced plans.
Initial Coverage Limit Phase
Confused about the initial coverage limit? Don't be, because it's straight forward. If you enroll in the Anthem Blue MedicareRx Standard PDP, you share the cost of your prescriptions with Blue MedicareRx. You each pay your share until the amount spent at the pharmacy reaches $3750.00. That's the initial coverage limit in Ohio for plan year 2018. After that you are not covered (coverage gap) until your actual out-of-pocket costs qualify you for catastrophic coverage. Keep reading, because you are entitled to automatic discounts.
Coverage Gap Phase
If you reach the coverage gap phase, or donut hole, as many people call it, you are essentially uninsured and must pay for all of your prescription costs out-of-pocket. When you reach the coverage gap with the Anthem Blue MedicareRx Standard plan will all depend on your prescriptions. Most people 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.
In the coverage gap phase you are responsible for the full cost of your prescription drugs up until your total out-of-pocket expenses reach $4,550 (excluding premiums and expense paid by insurance) minus a 47.5% discount on brand-name prescription drugs and a 28% discount on generic drugs. Once you reach $4,550 in out-of-pocket expenses, you're out of the coverage gap. At this point you automatically get catastrophic coverage through Medicare, which assures you only pay a small amount for covered drugs for the remainder of the year.
Enhanced Gap Coverage
Anthem Blue MedicareRx Standard does not offer coverage gap assistance. If went into the coverage gap phase last year, and you were unable to afford your prescriptions, call your local Ohio Medicaid office about assistance. The Extra Help program, from the Social Security Administration, may also be available to help you afford your medications.
Catastrophic Coverage Phase
Once you've spent $4,950 out-of-pocket in 2018, you're out of the coverage gap phase. At this point, you automatically get "catastrophic coverage." This assures that you'll only pay a small co-insurance or co-payment for covered drugs for the remainder of the year.
Co-payment & Co-insurance Details
In addition to the monthly premium and annual deductible, the Anthem Blue MedicareRx Standard prescription drug plan has co-payments (fixed dollar amount) and/or co-insurances (percentage) that you must pay when you pickup your medications. Here's the schedule for this plan:
|Tier||You Pay||Tier Description|
CRITICAL: To understand how much you will pay at the pharmacy if you join this plan, you must find the tier of each of your prescriptions in the plan's formulary.
TIP: Use the GoodRx Medicare tools to find your prescription at the best price in your town.
CMS 5-Star Ratings
The annual CMS plan ratings are important. Each year CMS rates PDPs across four categories. Ratings offer a good clue as to the quality of service you can expect if you join the plan.
|2018 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|
Blue MedicareRx Contact Information
Here's the new member contact information for Blue MedicareRx:
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 Anthem Blue MedicareRx Standard prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Cincinnati, Cleveland, Elyria, Columbus, Dayton, Akron, Toledo, Youngstown, Euclid, Parma, Canton, Lorain, Hamilton, Springfield, Kettering, Lakewood, Cuyahoga Falls, Middletown, and all other towns and cities in Ohio.
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