Learn About Medicare

Subsidies for People Who Need Extra Help

MedicareBlue PPO (Regional 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 than what it would be if you did not get extra help from Medicare. 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.

Your level of extra help	Monthly Premium for MedicareBlue PPO (Regional PPO)*
100%	$51.40
75%	$52.90
50%	$54.30
25%	$55.80

* 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 or 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 have any questions, please call Customer Service at 1-888-457-3009, (TTY/TDD: 1-888-457-3005) from 8 a.m. to 8 p.m., daily, Central and Mountain Time.

R5566_112409_C01 RE

March 17, 2010

Important Information

This page last updated and accepted by CMS January, 2010.

MedicareBlue Rx (PDP) is a Medicare-approved Part D sponsor. MedicareBlue PPO (Regional PPO) is a Medicare-approved regional PPO plan.

Coverage is available to residents of the service area or members of an employer or union group and separately issued by one of the following plans: Wellmark Blue Cross and Blue Shield of Iowa,* Blue Cross and Blue Shield of Minnesota,* Blue Cross and Blue Shield of Montana,* Blue Cross and Blue Shield of Nebraska,* Blue Cross Blue Shield of North Dakota,* Wellmark Blue Cross and Blue Shield of South Dakota,* and Blue Cross Blue Shield of Wyoming.*

*Independent licensees of the Blue Cross and Blue Shield Association.