2022 Blue Medicare Rx Standard (PDP) By Blue Cross and Blue Shield of North Carolina



Blue Medicare Rx Standard (PDP) is a Basic Alternative 2022 Medicare (Part-D) Prescription Plan by Blue Cross and Blue Shield of North Carolina. Stand-alone plans offer additional prescription drug coverage only and are an option if you are on Original Medicare insurance or you have a Medicare health plan that does not include Part D coverage. The Blue Medicare Rx Standard (PDP) plan has a monthly drug premium of $94.40 and a $400.00 drug deductible.



S5540-002 Part-D Summary of Bennefits

Plan Name:Blue Medicare Rx Standard (PDP)
Provider:Blue Cross and Blue Shield of North Carolina
Plan ID:S5540-002
Plan Year:2022
State: North Carolina

Benefit Type:Basic
Monthly Drug Premium:$94.40
Drug Deductible:$400.00
Tiers with No Deductible:1
Gap Coverage:No
National Plan:No
Similar Plan:S5540-004
New 2023 Plan:S5540-002


Deductible and Premium for Blue Medicare Rx Standard (PDP)

The Blue Medicare Rx Standard (PDP) plan has a monthly drug premium of $94.40 and a $400.00 drug deductible. This Blue Cross and Blue Shield of North Carolina plan offers a $94.40 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Blue Cross and Blue Shield of North Carolina above and beyond the standard PDP benefits. This can include additional help in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $94.40. The Part D Total Premium is the combined total of the supplemental and basic premiums for some plans this amount can be lower due to negative premiums.



Part D Basic Premium:$94.40
Benchmark:not below the regional benchmark
Part D Supplemental Premium$0.00
Benefit Type: Basic Alternative
Total Part D Premium:$94.40


Blue Cross and Blue Shield of North Carolina Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Blue Medicare Rx Standard (PDP) medicare insurance plan offers a $58.60 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $67.50 for 75% low income subsidy $76.50 for 50% and $85.40 for 25%.



$0 Premium with Full LIS:No
Full LIS Premium:$58.60
75% LIS Premium:$67.50
50% LIS Premium:$76.50
25% LIS Premium:$85.40


S5540-002 Gap Coverage

In 2022 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will still receive a 75% discount on covered brand-name drugs and a discount on generic drugs. Once you reach the coverage gap you will pay 25% of the plans cost for covered brand-name prescription drugs and 25% on generic drugs unless your plan offers additional coverage. This Blue Cross and Blue Shield of North Carolina plan does not offer additional coverage through the gap. If you are looking for additional health coverage you can see the North Carolina MA Plans here.



S5540-002 Formulary or Drug Prices

Blue Medicare Rx Standard (PDP) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 Blue Medicare Rx Standard (PDP) S5540-002 Formulary here.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 $4 $15
Tier 2 $8 $20
Tier 3 $37 $47
Tier 4 48% 50%
Tier 5 26% 26%
*Initial Coverage Phase and 30 day supply





Blue Medicare Rx Standard (PDP) Plan Reviews

2021 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


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Blue Medicare Rx Standard (PDP) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


Source: CMS.
Plans as of September 1, 2021.
Notes: Data are subject to change. All contracts for 2020 have been not finalized. For 2020, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Includes 2020 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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