MedicareBlue Rx Premier Part D Plan S5743-004 Details for Nebraska
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MedicareBlue Rx Premier is a 2025 Medicare Part D plan from MedicareBlue Rx that's available to individuals enrolled in a Medicare Advantage plan without prescription drug plan benefits or Medicare Part A and/or Part B.
This plan has a monthly premium of $116.90, an initial coverage limit of $5,030, an out-of-pocket threshold of $8,000, and a $0.00 deductible that must be paid before cost-sharing begins. *CMS rated this plan 3 (Average) out of 5 stars.
See more Medicare Part D Plans in Nebraska.
| Part D Plan Basics | |
|---|---|
| Plan ID: | S5743-004 |
| Plan Type: | PDP |
| Plan Year: | 2025 |
| Premium: | $116.90/mo |
| Deductible: | $0.00/yr |
| Benefit Type: | Enhanced |
| Low Income Subsidy: | Yes |
| Availability: | Nebraska |
| Insured By: | MedicareBlue Rx |
Prescription Drug Plan Premium
Although MedicareBlue Rx Premier 's monthly premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the premium details of this MedicareBlue Rx plan.
| Basic Part D Premium: | $71.60 |
| Supplemental Part D Premium: | $45.30 |
| Total Part D Premium: | $116.90 |
| Low Income Premium Subsidy: | $50.63 |
| Low Income Premium Subsidy CMS Pays: | $50.60 |
| Low Income Subsidy Premium: | $66.30 |
The Social Security Extra Help page has more information about the Low-Income Subsidy (“Extra Help”) program.
Prescription Drug Plan Deductible
This plan's Medicare Part D annual deductible is $0.00. You must pay this amount at the pharmacy before MedicareBlue Rx begins paying its share
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, MedicareBlue Rx Premier has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Retail | Mail Order | Out of Network |
|---|---|---|---|
| Preferred Generic | $0.00 | $15.00 | $15.00 |
| Generic | $0.00 | $20.00 | $20.00 |
| Preferred Brand | 20.00% | 25.00% | 25.00% |
| Non-Preferred Drug | 40.00% | 45.00% | 45.00% |
| Specialty Tier | 33.00% | 33.00% | 33.00% |
| *Deductible does not apply. | |||
2025 CMS Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates drug plans (Part D) in four broad categories. We do not recommend joining a plan with an overall rating of less than 3.0. Here are the most recent CMS ratings for this plan.
| CMS Measure | Star Rating |
|---|---|
| Overall Plan Rating | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Every plan covers drugs differently, so it's important to look at your total cost.
Contact MedicareBlue Rx
| Plan Website: | MedicareBlue Rx |
|---|---|
| Formulay Information: | MedicareBlue Rx Formulary Information |
| Pharmacy Information: | MedicareBlue Rx Pharmacy Information |
| Prospective Part D Members: | (866)434-2037 |
| Prospective Part D TTY Users: | 711 |
If you qualify for Original Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program at www.medicare.gov.
Citations & References
- MedicareBlue Rx, "http://www.YourMedicareSolutions.com", Last Accessed October 13, 2024
- Medicare.gov, "Explore your Medicare coverage options", Last Accessed March 2, 2024
- Medicare.gov, "How Part D works with other insurance", Last Accessed March 14, 2024
- Medicare.gov, "Costs for Medicare drug coverage", Last Accessed March 3, 2024
- SSA.gov, "Understanding the Extra Help With Your Medicare", Last Accessed March 9, 2024
- CMS.gov, "Landscape Source Files", Last Accessed October 3, 2024
- CMS.gov, "Medicare Part C & D Performance", Last Accessed October 11, 2024
- CMS.gov, "Benefits Data", Last Accessed October 9, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.