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Frequently Asked Questions
- Who is eligible for Medicare prescription drug coverage (Part D) benefits?
- When can I enroll?
- How do I enroll?
- What are my options if I have a Medicare Supplement plan with prescription drug benefits?
- What are my options if I have a plan with prescription drug benefits through my employer?
- Who qualifies for extra help in paying premiums for Medicare Prescription Drug Plan costs?
- How do I apply for extra help?
- What happens if I qualify for extra help in paying premiums for Medicare Prescription Drug Plan costs?
- Do I have to enroll in a Medicare prescription drug plan?
- What are my protections in this plan?
- Can I enroll if I do not have Medicare Parts A or B?
- Can I enroll if I already have a Medicare Advantage Plan?
- If my spouse needs prescription drug coverage, do they have to buy their own?
Who is eligible for Medicare prescription drug coverage (Part D) benefits?
To be eligible for Blue MedicareRx (PDP)SM, Medicare-approved prescription drug coverage, you must:
- be enrolled in Medicare Part A and/or Part B;
- reside in the state of Illinois; and
- not be enrolled in more than one Medicare Part D plan while enrolled in Blue MedicareRx (PDP).
When can I enroll?
Depending on your circumstances, there are three enrollment periods in which you can enroll.
- Initial Enrollment Period (IEP) - This is a seven month enrollment period for those newly eligible for Medicare by turning 65. The seven months consist of the three months before, the three 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) - Every year, anyone eligible for Medicare Prescription Drug coverage may either switch or enroll in Medicare Part D plan between November 15 - December 31.
- Special Enrollment Period (SEP) - There may be select circumstances in which a Medicare beneficiary can enroll in a Medicare Part D plan outside of the initial or annual enrollment periods. Some examples include, but are not limited to:
- A move outside of the plan's approved program service area
- Entering or leaving a qualified institution like a nursing home
- An enrolling or disenrolling from for a Medicare Advantage plan (medical and drug benefit)
- Eligible for Low Income Subsidy Assistance
- Become enrolled in Medicare or Medicaid
To obtain more detailed information on the Special Enrollment Period, please contact our Product Specialists, for specific details, at 1-877-213-1821, 8 a.m. - 8 p.m., Central time, 7 days a week. For the hearing or speech impaired, please call 1-888-285-2252.
Remember, 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. To learn more about the late enrollment penalty, please call our Product Specialist.
How do I enroll?
We offer three easy ways to enroll in Blue MedicareRx (PDP):
- Online: Complete our secure online enrollment form*.
- Phone: Call 1-877-213-1821, 8 a.m. - 8 p.m., Central time, 7 days a week. For the hearing or speech impaired, please call 1-888-285-2252.
- Mail: Download the enrollment form
, complete and mail to the address below:
Blue MedicareRx (PDP)
P.O. Box 3897
Scranton, PA 18505-9947
If you are unable to print the form, please call our Product Specialists. They can have an enrollment form mailed to you or help you enroll over the phone.
What are my options if I have a Medicare Supplement plan with prescription drug benefits?
If your Medicare Supplement plan has prescription drug coverage, you may do one of three things:
- Choose to keep your current Medicare Supplement plan by doing nothing.
- Enroll in a Medicare-approved prescription drug plan and then have the prescription drug benefit portion of your current Medicare Supplement plan removed. Your Medicare Supplement premium will be adjusted accordingly.
- Enroll in a Medicare-approved prescription drug plan and change to another Medicare supplement plan.
Please review your options carefully. You may incur a government-imposed late enrollment penalty if you choose to enroll in a Medicare-approved prescription drug plan after the enrollment period ends.
What are my options if I have a plan with prescription drug benefits through my employer?
If you currently have drug coverage through a group retiree or union plan, you need to determine if it is "creditable" coverage, meaning coverage with equal or greater value than the Medicare standard prescription drug plan. You can do this by checking with the benefits administrator at the employer/union through which you receive your retiree coverage.
If your coverage is creditable, it is not necessary to enroll in a Medicare Part D plan, such as Blue MedicareRx (PDP), unless you want to.
If your coverage is NOT creditable, you will want to consider enrolling in a Medicare Part D plan, such as Blue MedicareRx (PDP), in order to avoid a late enrollment penalty.
Who qualifies for extra help in paying premiums for Medicare Prescription Drug Plan costs?
Medicare beneficiaries whose income falls within certain guidelines set forth by CMS, the federal agency that administers the Medicare prescription drug program, may qualify for extra help. Eligibility is determined by the beneficiaries' annual income and assets. (Assets include savings and stock holdings, but not homes or cars.)
Get more information on CMS's policy on applying for extra help and the documentation required.*
If you don't know what level of extra help you qualify for, please refer to the section "How do I apply for extra help?" below for more information.
If you qualify for extra help, please use the chart below to determine 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.
Low Income Subsidy Premium
The premiums listed do not include the amount you pay for your Medicare Part B premium.
Your level of extra help |
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% |
$14.90 |
$0.00 |
$46.90 |
75% |
$22.80 |
$7.10 |
$54.80 |
50% |
$30.70 |
$14.10 |
$62.70 |
25% |
$38.60 |
$21.20 |
$70.60 |
This chart applies to all Blue MedicareRx plans (Standard, Value, and Plus)
If you pay up to this much in 2009 |
You will pay up to this much in 2010 |
$0 deductible |
$0 deductible |
$60 deductible |
$63 deductible |
$1.10 for generics and brands that are treated as generics $3.20 for brand name drugs |
$1.10 for generics and brands that are treated as generics $3.30 for brand name drugs |
$2.40 for generics and brands that are treated as generics $6.00 for brand name drugs |
$2.50 for generics and brands that are treated as generics $6.30 for brand name drugs |
No more than 15% coinsurance for all drugs |
No more than 15% coinsurance for all drugs |
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for seventy-five 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 this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.
How do I apply for extra help?
You can apply for extra help in one of three ways:
- Call Medicare at 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.
- Contact your State Medicaid Office.
- Call the Social Security Administration at 1-800-772-1213, 7 a.m. - 7 p.m. Eastern time, Monday - Friday. For the hearing or speech impaired, please call 1-800-325-0778.
What happens if I qualify for extra help in paying premiums for Medicare Prescription Drug Plan costs?
If you have qualified for extra help, the amount of your premium and costs at the pharmacy will be less than the published amounts. Once your enrollment in Blue MedicareRx (PDP) is accepted by CMS, Medicare will tell us how much assistance you are receiving and then we will send you information on the amount, if any, you will pay.
Do I have to enroll in a Medicare prescription drug plan (Part D)?
No. However, if you do not enroll during your initial enrollment period in a Medicare prescription drug plan (Part D), and then choose to enroll later, you may face a government-imposed late enrollment penalty of 1 percent for every month you delay. However, you will not be penalized if you have prescription drug coverage that's considered "creditable", meaning equal to or better than the standard Medicare prescription drug coverage.
For example:
Your current drug costs are $775 a year and you have no prescription drug coverage. You choose not to join a Part D plan in 2009. Three years later your drug expenses increase and you decide to join a Part D plan. You may have to pay a penalty of 1 percent a month for every month you delayed enrollment--or a higher premium of approximately 36%.
What are my protections in this plan?
Blue MedicareRx (PDP) agrees to stay in the program for a full year at a time. Each year, the plan decides whether or not to continue offering prescription drug coverage for the following year. Should we decide not to continue offering Blue MedicareRx (PDP), we will send you a letter explaining your options for Medicare prescription drug coverage in your area. Your Medicare coverage is not affected.
As for claims, if Blue MedicareRx (PDP) ever denies your prescription drug benefits, we will explain our decision to you. You always have the right to appeal and ask us to review the claim that was denied. In addition, if your physician prescribes a drug that is not on our formulary, is not a preferred drug, or is subject to additional utilization rules, you may ask us to make a coverage exception.
Can I enroll if I do not have Medicare Parts A or B?
No, you must be entitled to Medicare Part A and/or enrolled in Medicare Part B to be eligible for a Medicare prescription drug coverage.
To learn how to get Medicare Part A and/or Part B, please call Medicare at 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.
You may also contact your State Medicaid Office or the Social Security Administration at 1-800-772-1213, 7 a.m. - 7 p.m. Eastern time, Monday - Friday. For the hearing or speech impaired, please call 1-800-325-0778.
Can I enroll if I already have a Medicare Advantage Plan?
It depends. If you get prescription drug benefits from your Medicare Advantage (MA) plan, you cannot enroll in Blue MedicareRx (PDP). You cannot have a Medicare Advantage plan and a prescription drug plan at the same time.
However, if you are a member of a Private Fee-for-Service MA Plan (PFFS) that does not provide drug coverage, you can enroll in Blue MedicareRx (PDP).
Your Medicare Advantage (MA) Plan will let you know about the prescription drug options they will offer. You can also choose to switch to another Medicare Advantage Plan or Medicare Health Plan or you can choose to enroll in a Medicare Supplement Plan and join a Medicare Prescription Drug Plan.
If my spouse needs prescription drug coverage, do they have to buy their own?
Yes. Blue MedicareRx (PDP) is sold only on an individual basis. The advantage to this is that you and your spouse can each purchase the plan that best meets your needs. For example, if you want/need the Value plan and your spouse wants/needs the Plus plan, you can each select the plan that best meets your individual needs rather than both purchasing the same plan.
Please call a Product Specialist for a document available in alternate formats or languages.
* By clicking this link you will leave the Blue MedicareRx (PDP) Web site. Indicates a file in portable document format (PDF). To view this file, you may need to install Adobe® Reader®*. The latest version of Adobe Reader has built-in screen reader capability. Other accessibility tools and information can be downloaded at http://access.adobe.com*.
Last updated 11/22/09 - S5715_WEB_IL_PDPb
CMS Approved 3/2010
