Blue Care Network of Michigan: Part D prescription drug coverage

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BCN Advantage » Individual options » Part D prescription drug coverage

Individual Part D prescription drug coverage

For more information call:
1-877-469-2583
TTY 1-800-481-8704
Seven days a week
8 a.m. to 8 p.m. Eastern Time

BCN Advantage Basic

BCN Advantage Basic has a $310 Part D deductible and provides Part D prescription drug coverage with no drug coverage while in the coverage gap. The gap begins when you reach your initial coverage limit of $2,840, calculated by adding payments made by the plan and you. After you reach this limit, you pay 93% of the cost of generic drugs and a discounted price for brand-name drugs until your yearly out-of-pocket costs reach $4,550 and you qualify for catastrophic coverage. During catastrophic coverage, you will pay: the greater of $2.50 for generics (or drugs that are treated like generics) and $6.30 or 5% coinsurance for all other drugs. We will pay the rest.

BCN Advantage Option 2

BCN Advantage Option 2 provides Part D prescription drug coverage with drug coverage for generic medicines only while in the coverage gap. The gap begins when you reach your initial coverage limit of $2,840, calculated by adding payments made by the plan and you. The gap begins when you reach your initial coverage limit of $2,840, calculated by adding payments made by the plan and you. The plan covers Preferred Generic Drugs (Tier 1) through the coverage gap. After your total drug costs reach $2,840, you will have the following coverage for Preferred Generic Drugs (Tier 1) only:

45% coinsurance for a 90-day supply of generic drugs covered in this tier from a preferred retail pharmacy or mail order pharmacy
50% coinsurance for up to a 90-day supply of generic drugs covered in this tier from other types of pharmacies

For other covered drugs after your total yearly drug costs reach $2,840, you pay 93% for all non-Tier 1 generics and a discounted price for brand-name drugs until your yearly out-of-pocket drug costs reach $4,550, and you qualify for catastrophic coverage. During catastrophic coverage, you will pay: the greater of $2.50 for generics (or drugs that are treated like generics) and $6.30 or 5% coinsurance for all other drugs. We will pay the rest.

BCN Advantage Option 3

BCN Advantage Option 3 provides Part D prescription drug coverage with coverage for generic medicines only while in the coverage gap. The gap begins when you reach your initial coverage limit of $2,840, calculated by adding payments made by the plan and you. After your total drug costs reach $2,840, you will have the following coverage for Preferred Generic Drugs (Tier 1) only:

$5 copay for a one-month (34-day) supply of all drugs covered in this tier from a preferred or non-preferred pharmacy
$12.50 copay for a three-month (90-day) supply of all drugs covered in this tier from a preferred pharmacy
$15 copay for a three-month (90-day) supply of all drugs covered in this tier from a non-preferred pharmacy

Important information about this plan

BCN Advantage HMO-POS℠
BCN Advantage HMO-POS is available in these counties: Allegan, Barry, Bay, Calhoun, Clinton, Eaton, Genesee, Gratiot, Ingham, Ionia, Jackson, Kalamazoo, Kent, Lapeer, Livingston, Macomb, Midland, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Ottawa, Saginaw, Shiawassee, St. Clair, Tuscola, Van Buren, Washtenaw and Wayne. Premiums vary by county. You must have both Part A and B and continue to pay your Medicare Part B premium.

You must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers neither Medicare nor BCN Advantage HMO-POS will be responsible for the costs, and your care may cost more than in-network pricing. Limitations, copayments and restrictions may apply.

If you are enrolled in BCN Advantage HMO-POS Basic, Option 2 or Option 3, you must use a network pharmacy to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use a network pharmacy. Quantity limitations and restrictions may apply. Our pharmacy network includes the majority of chain pharmacies, mail order through Medco or Walgreens, as well as long-term care and home infusion pharmacies. For additional information on network pharmacies, please call Customer Services at 1-800-450-3680, 8 a.m. to 8 p.m., seven days a week. TTY users should call 1-800-430-3211. You may also write to: BCN Advantage HMO-POS, P.O. Box 5184, Mail Code A103, Southfield, MI 48086-5184

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 January 1, 2012.

If you decide to have your BCN Advantage HMO-POS 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.

Medicare beneficiaries may enroll in BCN Advantage HMO-POS 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. Beneficiaries may only enroll during specific times of the year. 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:

1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
Your State Medicaid Office.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to one hundred (100) 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.

Please call customer service at the number listed above to have any information verbally translated into another language.

A health plan with a Medicare contract.

H5883_BCNAdvantageWebR2 CMS Approved 05242011

page modified 09/23/2011