Horizon Medicare Blue Rx Standard (PDP)
Health Insurance Company: Horizon Blue Cross Blue Shield of New Jersey
Medicare Prescription Drug Part D Plan Details
$65 /mo
monthly premium
Horizon Medicare Blue Rx Standard (PDP)
Coverage
Overall Star Rating (2024)
- Rx
General Plan Details
Prescription Drug Deductible
$545
Preferred Generic copay
$10
Preferred Brand copay
$40
Eligible for Low Income Subsidy
No
Rx Drug Coverage - Standard Retail Cost
Tier 1: Preferred Generic
$10.00 copay (30-day supply)
$30.00 copay (90-day supply)
Tier 2: Generic
$20.00 copay (30-day supply)
$60.00 copay (90-day supply)
Tier 3: Preferred Brand
$40.00 copay (30-day supply)
$120.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
45% coinsurance (30-day supply)
45% coinsurance (90-day supply)
Tier 5: Specialty Tier
25% coinsurance (30-day supply)
Plan Links
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Where This Plan is Available
Additional Plan Info
Year:
2024
Plan ID:
S5993-001-0
Insurance Company Website:
Horizon Blue Cross Blue Shield of New Jersey