Print this pageAbout Medicare Part D
General Overview
In 2003, Congress passed the Medicare Modernization Act (MMA) into law. Among the many changes that resulted from this legislation was the addition of prescription drug coverage for Medicare-eligible beneficiaries.
Medicare prescription drug coverage, also known as Medicare Part D, allows Medicare beneficiaries to purchase prescription drug coverage through private insurance companies in an effort to alleviate the financial burden of rising drug costs. Before insurance companies can sell Medicare Part D coverage, they must have their benefits, premiums, and formulary (list of covered drugs) approved by the Centers for Medicare and Medicaid Services (CMS), the federal agency that administers the Medicare program. This is to ensure they are complying with the guidelines set forth within the legislation.
In the initial enrollment period alone, over 38 million Medicare beneficiaries enrolled in a Medicare Part D plan†.
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Eligibility
To be eligible for enrollment in Medicare Part D, enrollees must meet the following requirements:
- be entitled to Medicare benefits under Part A and/or enrolled in Part B;
- reside in the plan's service area; and
- not be enrolled in more than one Medicare Part D plan at a time.
Enrollment Periods & Penalties
There are three types of enrollment periods during which Medicare-eligible beneficiaries may enroll.
- Initial Enrollment Period (IEP) - This is a seven (7) month enrollment period for those who are newly eligible for Medicare as a result of turning 65. The seven month period consists of the three (3) months before, the three (3) months after, and the month of the applicant's 65th birthday.
Those who are under 65 with a disability may also be eligible to enroll. - Annual Enrollment Period (AEP) - Between November 15 and December 31 of each year, anyone eligible for Medicare Prescription Drug coverage may either switch or enroll in a Medicare Part D plan.
- Special Enrollment Period (SEP) - There are several very special circumstances that would allow a Medicare-eligible recipient to enroll in a Medicare Part D plan outside of the initial or annual enrollment periods. Some examples include, but are not limited to:
- moving into the service area;
- involuntarily losing creditable coverage;
- becoming dual eligible.
If you choose not to enroll during these required time frames, the federal government may impose a late enrollment penalty of 1% per month for every month you delay enrollment. This penalty may be assessed regardless if you later enroll during a required enrollment period because the enrollment penalty applies for every month in which you could have enrolled but did not. To learn more about the late enrollment penalty, please call our Customer Service Department at 1-888-285-2249, 8 a.m. - 8 p.m. CST. For the hearing or speech impaired, please call 1-888-285-2252.
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Availability of Medicare Subsidy Information
You may be able to receive extra help for your prescription drug premiums and costs. If you qualify for extra help from Medicare to pay for your prescription drug coverage, your premium and drug costs will be lower. The amount of extra help you receive will determine your monthly premium.
To see if you qualify for extra help, call:
- 1-800-MEDICARE (1-800-633-4227), 24 hours a day/7 days a week. For the hearing or speech impaired, please call 1-877-486-2048, or
- The Social Security Administration at 1-800-772-1213, 7 a.m. - 7 p.m., Monday - Friday. For the hearing or speech impaired, please call 1-800-325-0778.
- Your State Medicaid Office.
If you continue to qualify for the same amount of extra help in 2008, the chart below tells how much you will pay for a monthly premium in each of our three plans (Standard, Value, and Plus). The amount you pay is based on your level of extra help. This premium does not include the amount you pay for your Medicare Part B premium.
Please review the chart below to determine if you may qualify for extra help.
Low Income Subsidy Premium
|
Your level of |
Monthly premium for the Blue MedicareRx Standard Plan |
Monthly premium for the Blue MedicareRx Value Plan |
Monthly premium for the Blue MedicareRx Plus Plan |
|
100% |
$1.30 |
$0.00 |
$39.80 |
|
75% |
$8.90 |
$6.90 |
$47.40 |
|
50% |
$16.50 |
$13.90 |
$55.00 |
|
25% |
$24.00 |
$20.80 |
$62.50 |
The premiums listed do not include the amount you pay for your Medicare Part B premium.
|
If you pay up to |
You will pay up to |
|
$0 deductible |
$0 deductible |
|
$53 deductible |
$56 deductible |
|
$1 for generics and brands that are treated as generics |
$1.05 for generics and brands that are treated as generics |
|
$2.15 for generics and brands that are treated as generics |
$2.25 for generics and brands that are treated as generics |
|
No more than 15% co-insurance for all drugs |
No more than 15% co-insurance for all drugs |
This chart applies to all plans (Standard, Value, and Plus)
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