2012 Medicare plans (Switch plan year)

Prescription Blue PDPSM

Prescription Blue PDP is our Medicare-approved prescription drug plan. It's drug coverage you can count on*.

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Simple and Affordable Prescription Drug Coverage

Prescription Blue PDPSM Option A premium is $59.60 per month, and Option B is $85.90 per month. Download a plan brochure (PDF 291KB) for more information.

* Prescription drug coverage benefits subject to limits and copayments.

Contact your Blues contracted agent

Contact your Blues contracted agent or an independent agent licensed to sell Blues Medicare Advantage plans, or call us for more information:

Member Services representatives are available 8 a.m. to 8 p.m. seven days a week.

Turning 65?

If you're turning 65 or qualify for Medicare under special circumstances, you don't have to wait for Medicare's annual enrollment period, from Oct. 15 through Dec. 7. Call the Member Service number above for more information.

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:

Complaint?

For information about filing a Medicare complaint, please visit:
www.medicare.gov/navigation/help-and-support/filing-a-complaint-or-grievance.aspx

To file a complaint with Medicare, click here:
www.medicare.gov/MedicareComplaintForm/home.aspx

Prescription Blue PDP information

Let us help you

H9572 S5584_W_12BCBSMAdvantageWebR2 CMS Approved 04262012

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to seventy-five (75) 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 the Extra Help program, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days per week. TTY users should call 1-877-486-2048.

Important information about these plans

Prescription Blue PDPSM is a stand-alone prescription drug plan with a Medicare contract.

Prescription Blue PDP is available to all Medicare beneficiaries who are Michigan residents entitled to receive services under Medicare Part A and/or enrolled in Part B. Premiums vary by county. You must continue to pay your Medicare Part B premium.

Limitations, copayments and restrictions may apply.

Our network includes approximately 2,300 Michigan retail pharmacies, of which 86 percent are network pharmacies. Nationwide, most chain pharmacies are in our network, as well as long-term care and home infusion pharmacies and Indian/Tribal/Urban (Indian Health Service) pharmacies.

In general, benefits are only available at contracted network pharmacies. Plan drugs may be covered in special circumstances, for instance, illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost sharing amount if you get your drugs at an out-of-network pharmacy. Quantity limitation and restrictions may apply. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Blue Cross Blue Shield of Michigan. For additional information on network pharmacies, please call Member Services at 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704. You may also write to: Blue Cross Blue Shield of Michigan, 600 E. Lafayette Blvd., Mail Code X435, Detroit, MI 48226.

If you decide to have your plan premium withheld from your Social Security check or deducted from your checking or savings account, it may take up to three months for the automatic deduction to begin. If your premium amount is currently withheld from your Social Security check or deducted from your checking or savings account and you wish to receive a monthly bill instead, the change may also take up to three months to become effective. During this time, you will be responsible for paying your premium.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on Jan. 1, 2013.

Medicare beneficiaries may enroll in Prescription Blue PDP through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. For more information, please contact Blue Cross Blue Shield of Michigan at 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704. To learn more about enrollment periods, please contact Member Services.