2018 Basic Blue Rx (PDP) S6986-1-0 in MI from Select Account | HealthPocket

Basic Blue Rx (PDP)

$24/mo

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Zip Code48228
Applicant12/16/1983 Male
Coverage Start12/17/2018
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Benefits & Coverage

Insurance TypeMedicare Advantage Prescription Drug Plan (Part D)
Insurance ProviderSelect Account
Plan IDS6986-1-0
Plan Year2018
CMS RatingNot Rated
Plan TypePDP
Annual Deductible$405.00

What To Know About This Plan
  • This is a drug coverage only plan
  • This plan is available for 2019. see plan

Costs and Other Important Information

Plan Year2018
Optional Supplemental BenefitsNo
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)Not Applicable
Other health plan deductibles?Yes
Health Plan DeductibleComing soon
Monthly Drug Plan Premium$24.90
Monthly Health Plan PremiumNot Applicable

Benefits

SERVICECOST
Inpatient hospital coverageComing soon
Outpatient hospital coverage20% per visit
Doctor visitsPrimary:
20% per visit
Specialist:
20% per visit
Preventive care20%
Emergency care/Urgent careEmergency:
20%
Urgent care:
20%
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
20%
Lab services:
20%
Diagnostic radiology services (e.g., MRI):
20%
Outpatient x-rays:
20%
Mental health servicesComing soon
Outpatient group therapy visit with a psychiatrist:
20%
Outpatient individual therapy visit with a psychiatrist:
20%
Outpatient group therapy visit:
20%
Outpatient individual therapy visit:
20%
Skilled Nursing FacilityComing soon
Rehabilitation servicesOccupational therapy visit:
20%
Physical therapy and speech and language therapy visit:
20%
Ambulance20%
TransportationNo
Foot care (podiatry services)Foot exams and treatment:
20%
Routine foot care:
20%
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
20% per item
Prosthetics (e.g., braces, artificial limbs):
20% per item
Diabetes supplies:
20% per item
Wellness programs (e.g., fitness, nursing hotline)No
Medicare Part B drugsChemotherapy:
20%
Other Part B drugs:
20%

Coverage Area for Basic Blue Rx (PDP)

StateMichigan
CountyWayne

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$4 copay$16 copay$4 copay
Tier 2: Non-Preferred Generic$9 copay$20 copay$9 copay
Tier 3: Preferred Brand Name15% coinsurance21% coinsurance15% coinsurance
Tier 4: Non-Preferred Brand Name30% coinsurance46% coinsurance30% coinsurance
Tier 5: Specialty Tier25% coinsurance25% coinsurance25% coinsurance

60 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$8 copay$32 copay$8 copay
Tier 2: Non-Preferred Generic$18 copay$40 copay$18 copay
Tier 3: Preferred Brand Name15% coinsurance21% coinsurance15% coinsurance
Tier 4: Non-Preferred Brand Name30% coinsurance46% coinsurance30% coinsurance
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$10 copay$40 copay$10 copay
Tier 2: Non-Preferred Generic$22.5 copay$50 copay$22.5 copay
Tier 3: Preferred Brand Name15% coinsurance21% coinsurance15% coinsurance
Tier 4: Non-Preferred Brand Name30% coinsurance46% coinsurance30% coinsurance
Tier 5: Specialty Tier

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - DrugsNot Rated
Appeals auto-forwardNot Rated
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug planNot Rated
Members choosing to leave the drug planNot Rated
Beneficiary access and performance problemsNot Rated
Drug plan quality improvementNot Rated

Member Experience with Drug Plan

Rating of drug planNot Rated
Getting needed prescription drugsNot Rated

Drug Pricing and Patient Safety

MPF Price AccuracyNot Rated
High risk medicationNot Rated
Part D medication adherence for diabetesNot Rated
Part D medication adherence for hypertensionNot Rated
Part D medication adherence for cholesterolNot Rated
Medication Therapy Management program completion rate Not Rated

Pharmacies that accept Basic Blue Rx (PDP) Prescription Drug Plan for Michigan

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.