Subsidies for People Who Need Extra Help
MedicareBlue PPO
Monthly Plan Premium for People who get Extra Help from Medicare to Help Pay for their Prescription Drug Costs
If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.
This table shows you what your monthly plan premium will be if you get extra help.
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Your level of extra help
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Monthly Premium for MedicareBlue PPO Essential Plus Rx 1*
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Monthly Premium for MedicareBlue PPO Enhanced Plus Rx 1*
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Monthly Premium for MedicareBlue PPO Enhanced Plus Rx 2*
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Monthly Premium for MedicareBlue PPO Enhanced Plus Rx 3*
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100%
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$40.50
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$80.60
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$113.40
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$170.40
|
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75%
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$43.10
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$82.90
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$121.00
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$178.00
|
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50%
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$45.70
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$85.30
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$128.70
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$185.70
|
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25%
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$48.40
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$87.60
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$136.30
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$193.30
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* This does not include any Medicare Part B premium you may have to pay.
MedicareBlue PPO’s premium includes coverage for both medical services and prescription drug coverage.
If you aren’t getting extra help, you can see if you qualify by calling:
- 1-800-MEDICARE (1-800-633-4227). TTY/TDD users call 1-877-486-2048, 24 hours a day/7 days a week;
- Your State Medicaid Office, or
- The Social Security Administration at 1-800-772-1213. TTY/TDD users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.
If you are a current member and have any questions, please call MedicareBlue PPO Customer Service at 1-800-457-3009, (TTY/TDD: 1-888-457-3005) from 8 a.m. – 8 p.m., daily, Central and Mountain Time.
R5566_091707_B02 RE CMS
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Your Count Down to Medicare