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Prescription Blue Select (PDP) - S5584-001-000
$122.80
Monthly Premium
Prescription Blue Select (PDP) is a Medicare Part D Prescription Drug Plan offered by Blue Cross Blue Shield of Michigan
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$122.80
Monthly Premium
Michigan Medicare beneficiaries may want to consider reviewing their Medicare prescription drug coverage options, such as a standalone Part D prescription drug plan (PDP) or a Medicare Advantage (Medicare Part C) plan that includes drug coverage.
A Part D plan can be used alongside your Original Medicare (Part A and Part B) coverage. A Medicare Advantage plan that includes drug coverage combines your Part A, Part B and Part D benefits into a single plan
Learn more about Michigan Medicare prescription drug plans like the one below and find a plan that offers the benefits you want at an affordable price.
Prescription Blue Select (PDP) - S5584-001-000 Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $122.80 |
| Annual deductible | $590.00 |
| Preferred pharmacies? | Yes |
| Accepts Mail Order? | Yes |
| Star Rating | 4 out of 5 stars |
Prescription Drug Costs and Coverage
The Prescription Blue Select (PDP) is a prescription drug plan which offers the following coverage:
Deductible Coverage Level
| Tiers | Tier 1 Preferred Generic Drug |
|---|---|
| Preferred retail | $1.00 |
| Standard retail | $6.00 |
| Preferred mail order | $1.00 |
| Standard mail order | $6.00 |
| Tiers | Tier 1 Preferred Generic Drug |
|---|---|
| Preferred retail | $3.00 |
| Standard retail | $18.00 |
| Preferred mail order | $3.00 |
| Standard mail order | $18.00 |
Initial Coverage Level
| Tiers | Tier 1 Preferred Generic Drug | Tier 2 Generic Drug | Tier 3 Preferred Brand Drug | Tier 4 Non-Preferred Drug | Tier 5 Specialty Tier Drug |
|---|---|---|---|---|---|
| Preferred retail | $1.00 | $6.00 | 23% | 25% | 25% |
| Standard retail | $6.00 | $11.00 | 23% | 25% | 25% |
| Preferred mail order | $1.00 | $6.00 | 23% | 25% | 25% |
| Standard mail order | $6.00 | $11.00 | 23% | 25% | 25% |
| Tiers | Tier 1 Preferred Generic Drug | Tier 2 Generic Drug | Tier 3 Preferred Brand Drug | Tier 4 Non-Preferred Drug | Tier 5 Specialty Tier Drug |
|---|---|---|---|---|---|
| Preferred retail | $3.00 | $18.00 | 23% | 25% | N/A |
| Standard retail | $18.00 | $33.00 | 23% | 25% | N/A |
| Preferred mail order | $3.00 | $18.00 | 23% | 25% | N/A |
| Standard mail order | $18.00 | $33.00 | 23% | 25% | N/A |
Plan Documents
| Links to plan documents |
Michigan Counties Served
- Alcona
- Alger
- Allegan
- Alpena
- Antrim
- Arenac
- Baraga
- Barry
- Bay
- Benzie
- Berrien
- Branch
- Calhoun
- Cass
- Charlevoix
- Cheboygan
- Chippewa
- Clare
- Clinton
- Crawford
- Delta
- Dickinson
- Eaton
- Emmet
- Genesee
- Gladwin
- Gogebic
- Grand Traverse
- Gratiot
- Hillsdale
- Houghton
- Huron
- Ingham
- Ionia
- Iosco
- Iron
- Isabella
- Jackson
- Kalamazoo
- Kalkaska
- Kent
- Keweenaw
- Lake
- Lapeer
- Leelanau
- Lenawee
- Livingston
- Luce
- Mackinac
- Macomb
- Manistee
- Marquette
- Mason
- Mecosta
- Menominee
- Midland
- Missaukee
- Monroe
- Montcalm
- Montmorency
- Muskegon
- Newaygo
- Oakland
- Oceana
- Ogemaw
- Ontonagon
- Osceola
- Oscoda
- Otsego
- Ottawa
- Presque Isle
- Roscommon
- Saginaw
- Saint Clair
- Saint Joseph
- Sanilac
- Schoolcraft
- Shiawassee
- Tuscola
- Van Buren
- Washtenaw
- Wayne
- Wexford