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Anthem MediBlue Rx Standard (PDP)

Anthem MediBlue Rx Standard (PDP) S5596-017 Plan Details
3.5 out of 5 stars

Anthem MediBlue Rx Standard (PDP) is a plan offered by Anthem Inc..
Plan ID: S5596-017.

$54.00
Monthly Premium

Anthem MediBlue Rx Standard (PDP) is a plan offered by Anthem Inc..
Plan ID: S5596-017.

Anthem MediBlue Rx Standard (PDP) S5596-017 Plan Details
3.5 out of 5 stars

Anthem MediBlue Rx Standard (PDP) is a plan offered by Anthem Inc..
Plan ID: S5596-017.

$54.00
Monthly Premium

Indiana Counties Served

Adams Bartholomew Benton Boone Clark Daviess Jasper Allen Blackford Brown Carroll Cass Clay Clinton Crawford Dearborn Decatur Dekalb Delaware Dubois Elkhart Fayette Floyd Fountain Franklin Fulton Gibson Grant Greene Hamilton Hancock Harrison Hendricks Henry Howard Huntington Jackson Jay Jefferson Jennings Johnson Knox Kosciusko La Porte Lagrange Lake Lawrence Madison Marion Marshall Martin Miami Monroe Montgomery Morgan Newton Noble Ohio Orange Owen Parke Perry Pike Porter Posey Pulaski Putnam Randolph Ripley Rush Scott Shelby Spencer St Joseph Starke Steuben Sullivan Switzerland Tippecanoe Tipton Union Vanderburgh Vermillion Vigo Wabash Warren Warrick Washington Wayne Wells White Whitley

Kentucky Counties Served

Adair Allen Anderson Barren Boone Boyd Bullitt Floyd Henderson Jefferson Ballard Bath Bell Bourbon Boyle Bracken Breckinridge Butler Caldwell Calloway Campbell Carlisle Carroll Carter Casey Christian Claiborne Clark Clay Clinton Crittenden Cumberland Daviess Edmonson Elliott Estill Fayette Fleming Franklin Fulton Gallatin Garrard Grant Graves Grayson Green Greenup Hancock Hardin Harlan Harrison Hart Henry Hickman Hopkins Jackson Jessamine Johnson Kenton Knott Knox Larue Laurel Lawrence Lee Leslie Letcher Lewis Livingston Logan Lyon Madison Magoffin Marion Marshall Martin Mason Mccracken Mccreary Mclean Meade Menifee Mercer Metcalfe Monroe Montgomery Morgan Muhlenberg Nelson Nicholas Ohio Oldham Owen Owsley Pendleton Perry Pickett Pike Powell Pulaski Robertson Rockcastle Rowan Russell Scott Shelby Simpson Spencer Taylor Todd Trigg Trimble Union Warren Washington Wayne Webster Whitley Wolfe Woodford

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $505
Out of Pocket Max In-Network: $-1
Out-of-Network: N/A
Initial Coverage Limit $4660
Catastrophic Coverage Limit $7,400

Prescription Drug Costs and Coverage

The Anthem MediBlue Rx Standard (PDP) plan offers the following prescription drug coverage, with an annual drug deductible of $505 (excludes Tiers 1 and 2) per year.

Coverage
Cost
Coverage & Cost
Annual Drug Deductible $505 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share retail $1.00
  • Standard retail $3.00
  • Standard mail order $1.00
Generic
  • Preferred cost-share retail $3.00
  • Standard retail $5.00
  • Standard mail order $3.00
Annual Drug Deductible $505 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share retail $2.00
  • Standard retail $6.00
  • Standard mail order $2.00
Generic
  • Preferred cost-share retail $6.00
  • Standard retail $10.00
  • Standard mail order $6.00
Annual Drug Deductible $505 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share retail $3.00
  • Standard retail $9.00
  • Standard mail order $3.00
Generic
  • Preferred cost-share retail $9.00
  • Standard retail $15.00
  • Standard mail order $9.00
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