Your 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 didn't 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.

 

These tables show you what your monthly plan premium will be if you get extra help.

Your level of Extra Help

Monthly Premium for Medicare HMO Blue ValueRx*

Monthly Premium for Medicare HMO Blue FlexRx*

Monthly Premium for Medicare HMO Blue PlusRx*

100%

$11.30

$64.90

$260.20

75%

$18.20

$73.40

$268.90

50%

$25.10

$81.90

$277.60

25%

$32.10

$90.50

$286.30

*This does not include any Medicare Part B premium you may have to pay.

Your level of Extra Help

Monthly Premium for Medicare PPO Blue SaverRx*

Monthly Premium for Medicare PPO Blue ValueRx*

Monthly Premium for Medicare PPO Blue PlusRx*

100%

$0

$44.40

$195.20

75%

$0

$53.00

$203.90

50%

$0

$61.70

$212.60

25%

$0

$70.30

$221.30

*This does not include any Medicare Part B premium you may have to pay.

 

These premiums include 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 of 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 Member Service at 1-800-200-4255, (TTY/TDD: (711) from 8:00 a.m. to 8:00 p.m. ET, 7 days a week from October 1 through February 14 and 8:00 a.m. to 8:00 p.m. ET, Monday through Friday from February 15 through September 30.

If you believe you qualified for extra help and that you are paying an incorrect copayment amount when you get your prescription at a pharmacy, Blue Cross Blue Shield of Massachusetts has established a process that will allow you to either request assistance in obtaining evidence of your proper copayment level, or, if you already have the evidence, to provide this evidence to us. This is known as the Best Available Evidence Policy. Please contact Member Services for a complete list of acceptable forms of evidence or view the CMS Best Available Evidence Policy.

Blue Cross Blue Shield of Massachusetts is a HMO and PPO plan with a Medicare contract. Enrollment in Blue Cross Blue Shield of Massachusetts depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Premium may change on January 1 of each year.