BlueMedicare Value Rx (PDP)
Plan costs
Premium $48.90 monthly
Benefits
| Pharmacy coverage | |
|---|---|
| Prescription deductible | $590 on Tier 3, Tier 4, and Tier 5 |
| Out-of-Pocket | $2,000 |
| One-Month Supply (Retail Pharmacy) with Standard Cost Sharing | |
| Preferred Generic | $4 copay |
| Generic | $15 copay |
| Preferred Brand | 20% coinsurance |
| Non-Preferred Drug | 44% coinsurance |
| Specialty Tier | 25% coinsurance |
| Insulin Products | $35 copay for a one-month supply |
| 100-Day Supply (Mail-Order Pharmacy) with Standard Cost Sharing | |
| Preferred Generic | $12 copay |
| Generic | $45 copay |
| Preferred Brand | 20% coinsurance |
| Non-Preferred Drug | 44% coinsurance |
| Specialty Tier | Not covered |
| Insulin Products | $70 copay for a two-month supply or $105 for a three-months supply (excluding Tier 5) |
| Plan Documents | |
|---|---|
| Summary of Benefits | BlueMedicare Value Rx (PDP) 2025 Summary of Benefits |
| Plan Documents | BlueMedicare Value Rx (PDP) Plan Documents |
Preferences
Plan: S5795-003
Limitations, copayments, and restrictions may apply. See above or contact the plan for more details.
*Enrollee must continue to pay the Medicare Part B premium.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:
- 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048. 24 hours a day, 7 days a week.
- The Social Security Office at 800-772-1213. TTY users should call 1-800-325-0778. Monday through Friday, 7:00 a.m. to 7:00 p.m.
- Your State Medicaid Office.
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