Blue Shield Medicare Enhanced Plan Prescription Plan for California Medicare Beneficiaries
| Overall Plan Rating: |  |
|---|---|
| Monthly Premium: | $72.50 |
| Pharmacy Co-Pay: | $0.00 |
| Coverage Limit (ICL): | $2,970.00 |
| Pharmacy Mail Order: | Yes |
| Gap Coverage: | No Gap Coverage |
| Low Income Subsidy: | No |
| Medicare Formulary: | 2947 |
| PDP ID No: | S2468-004 |
| Plan Year: | 2013 |
| Approved by CMS for: | CA Residents |
| Rx Plan Type: | Regional |
| Est. Regional Members: | 36708 |
2018 Medicare Prescription Medication Plan Overview
Blue Shield Medicare Enhanced (PDP) is an approved Medicare Prescription Drug Plan (Part D) for California seniors.
The annual premium is $870.00 ($72.50 monthly), and it carries a $0.00 deductible on all prescribed medications. Since it has a zero dollar deductive, you have coverage from the first dollars spent. Note that many plans have a policy deductible that must be paid in full prior to receiving prescription coverage assistance.
The Blue Shield of California formulary ID for this plan is 00012107, and it features 2947 FDA approved medications.
For all California seniors with Medicare benefits, there are two conditions that can change the amount you pay for your plan. The first is quailfying for the Extra Help program, which lowers your premium. The second is the opposite: if a premium penalty has been imposed on you for not enrolling right away at age 65 open enrollment, then your premium will be marginally higher.
Below are a few plans that are comparable to Blue Shield Medicare Enhanced Plan:
- WellCare Classic at $33.00 per month for California Seniors
- Humana Enhanced at $47.40 per month for California Seniors
- AARP MedicareRx Preferred at $47.90 per month for California Seniors
Blue Shield Medicare Enhanced Plan Initial Coverage
In the ICP (Initial Coverage Phase) the cost of your prescriptions is shared with your insurance company. You and the carrier each pay your share (as determined by the plan) until you reach the Initial Coverage Limit (ICL). In 2013, the ICL is $2,970 and this number changes each year. No deductible means your initial coverage phase begins immediately.
Each prescription medication is put into a tier within each Medicare Part D plan's drug formulary. Different tiers have different levels of cost-sharing. It's important to note that these tiers are not completely standardiszed and your prescriptions may be found in different tiers on differnt plans. This is why we provide access to all Part D plans' drug formularies, so you can compare what the cost is for your prescription drugs for different Part D plasn in your area.
The pharmacy co-pay with the Blue Shield Medicare Enhanced (PDP) plan in California is tiered as follows:
| Tier | Co-Pay Amount | Medications in Tier |
|---|---|---|
| 1 | $7.00 | 1397 Preferred Generics |
| 2 | $45.00 | 723 Non-Preferred Generics |
| 3 | $75.00 | 301 Preferred Brands |
| 4 | 33% | 350 Non-Preferred Brands |
| 5 | 33% | 176 Specialty Medications |
The Initial Coverage Limit (ICL) is $2,970.00. This prescription plan does not qualify for the $0 LIS premium.
Blue Shield Medicare Enhanced (PDP) 2013 Coverage Gap
The Coverage Gap (aka, "Donut Hole") is the coverage phase where you must pay all of your medication costs. Some plans provide donut hole coverage, and if you think that your drug costs will be high enough to get to this level, you should consider a plan with donut hole coverage. You can learn more about costs in the donut hole by reading What is the Medicare Part D Donut Hole? How long it will take you to reach the donut hole with the Blue Shield Medicare Enhanced (PDP) plan depends on your specific prescriptions.
The Gap Coverage with this policy: You must pay the $3727.50.
Plan Members
Nationwide, the number of seniors using the Blue Shield Medicare Enhanced Plan policy is 36,708. In region 32 (your region) there are approximately 36,708 people with this policy (based on 2011 CMS statistics).
More Information About Blue Shield of California
Blue Shield of California, an independent member of the Blue Shield Association, is a not-for-profit health plan dedicated to providing Californians with access to high-quality health care at an affordable price. As a not-for-profit, mission-driven health plan, Blue Shield is committed to universal coverage and the success of health reform, which will only be achieved if health care is affordable.
The summary (overall) rating for this Blue Shield of California plan is 4.0 out of 5 based on reviews from 36708 user ratings from the previous year. For more information about the review process, visit http://cms.gov.