AR Blue Cross - Medi-Pak Rx Basic, AR 2013 PDP
|Initial Coverage Limit:||$2,970.00|
|Gap Coverage:||No Gap Coverage|
|$0 Premium LIS Benefit:||Yes|
|Drugs in Formulary:||2837|
|Drug Plan ID:||S5795-003|
|CMS Approved for:||AR Residents|
|Members in Region:||25946|
PDP Plan Highlights
AR AR Blue Cross - Medi-Pak Rx Basic (PDP) is a Medicare prescription drug plan underwritten by Arkansas Blue Cross And Blue Shield for eligible residents of Arkansas. The plan is approved by CMS for drug formulary 00012061, which has 2837 FDA approved medications. The monthly premium is $31.40 ($376.80 for a full 12 months) and the pharmacy deductible is $325.00 per year. The highest deductible allowed by CMS for 2013 is $325.
Arkansas seniors, be aware that a few different circumstances may decrease or increase your actual premium. Specifically, if you qualify for Extra Help (full or partial), your premium will decrease. On the other hand, if you have a premium penalty, your premium will be slightly more.
AR Blue Cross - Medi-Pak Rx Basic Initial Coverage Phase
The Initial Coverage Phase (ICP) is your plan’s cost-sharing phase. During the ICP both you and your insurance provider share the cost of your prescription medications. This plan has a deductible, so your ICP does not start until the deductible has been paid.
Each medication is put into a tier within the plan’s formulary. This is simply a way for the insurer to manage cost-sharing. It’s important to note that every plan can put medications on any tier they deem suitable. This is not standardized, because it is based on cost and the various risk models used by the insurers.
The tiered prescription cost sharing (e.g., pharmacy co-pay) in Arkansas with this plan is as follows:
|Tier||Co-Pay Amount||Medications in Tier|
|1||$6.00||1786 Preferred Generics|
|2||$45.00||712 Non-Preferred Generics|
|3||$84.00||96 Preferred Brand Drugs|
|4||25%||243 Non-Preferred Brand Drugs|
|5||0 Specialty Drugs|
The 2012 Initial Coverage Limit with AR Blue Cross - Medi-Pak Rx Basic is $2,970.00. This drug plan qualifies for the full LIS benefit and a zero dollar monthly premium.
Coverage Gap Phase
The Coverage Gap, also known as the Donut Hole is the phase of your Part D plan where you must pay all of your medication costs. Healthcare Reform offers some additional assistance. For 2012 your insurance carrier will pay 7% of your generic drug prescription costs for you while you are in the donut hole. Likewise, the brand-name drug pharmaceutical companies cover half (50%) of your brand-name drug prescription costs. These subsidies count toward your True Out of Pocket (TrOOP) costs.
Some Medicare Part D plans provide additional Coverage Gap assistance that covers you above and beyond the discounts mandated by the Healthcare Reform Act. It’s important to note that if you have prescriptions that are not covered under your plan’s Gap Coverage, you will still get the generic and brand name drug discounts listed above, even if the plan itself does not offer gap coverage.
Here's how the carrier defines the 'donut hole' gap coverage for this policy: You must pay the $3727.50.
The number of Medicare recipients using the AR Blue Cross - Medi-Pak Rx Basic plan nationally is 25,946. In your area (CMS PDP region 19) there are a reported 25,946 seniors on this plan. That's based on the previous year's reporting information.
Facts About Arkansas Blue Cross And Blue Shield
Founded in 1948, Arkansas Blue Cross and Blue Shield, an Independent Licensee of the Blue Cross and Blue Shield Association, is the largest health insurer in Arkansas. Arkansas Blue Cross and its family of affiliated companies have approximately 2,870 employees. Arkansas Blue Cross differs from commercial insurers in several ways. Arkansas Blue Cross is a not-for-profit mutual insurance company. As a not-for-profit, mutual insurance company, Arkansas Blue Cross is owned by its policyholders, not by stockholders. This means that premium dollars are used solely to pay claims and administrative costs, not to pay stock dividends. Any excess funds are held in reserve for payment of future claims.
The main office of Arkansas Blue Cross is located at 601 S. Gaines Street in downtown Little Rock. Arkansas Blue Cross operates full-service regional offices serving seven designated geographic areas of the state. The Regional Offices, headquartered in Fayetteville, Fort Smith, Hot Springs, Little Rock, Jonesboro, Pine Bluff and Texarkana, offer sales, customer service, medical management and provider relations services to counties in their parts of the state.
Essential Information About Medicare Part D
Pharmacy contracts will vary with every drug program. Some plans have stringent regional restrictions, such as state borders, while others provide national coverage. Should you have an active life which often includes regular traveling, it's going to benefit you to have a policy that allows you to use drug stores in all states.
Medicare Part D plans use a specified service area. This is the area where the provider operates. To sign up, you have to reside in the plan’s service area. Remember that nearly all carriers provide mail-order solutions. This way you can have your medications shipped directly to your residence. Your agent can help you select a program that meets what you need, so don’t hesitate to simply call and ask.
Each and every healthcare insurance company sets its own prices. Monthly premiums for approved drug plans vary widely, even to get identical coverage, so it will pay you to look before you purchase.
Insurance companies publicize new prices along with other premium details each October. Be sure to take a look at and compare premiums each year prior to open enrollment.
Be aware that if you do not register for a Medicare Part D insurance policy once you first are eligible, your future payments will probably be higher. This late entry consequence is set by Medicare, not the insurance plan providers. Each month you delay following eligibility you will pay an additional 1% each month forever.