To enroll in RxBLUE PDP, you must be entitled to Medicare Part A and/or enrolled in Medicare Part B AND live in Louisiana. Some enrollment restrictions apply.
Print a 2013 enrollment form, fill it out and return it to:
P.O. Box 80699
Baton Rouge, LA 70898-9900
Online enrollment is not available.
Medicare beneficiaries may also enroll in RxBLUE PDP through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov/. For more information, contact RxBLUE PDP at 1.888.223.2583 (TTY: 1.800.947.5277) from 8 a.m. to 8 p.m., seven days a week.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:
Your premium amount may be lower if you are eligible for Extra Help. Call Medicare at the numbers above to determine your percentage of help and view our Low Income Subsidy Premium Chart for more information.
If you are turning 65, you may enroll within the three months before or the three months after the month of your 65th birthday. This seven-month window is known as your Initial Election Period. If you wish to join after the Initial Election Period, you will have to wait until the next Annual Election Period, which occurs Oct. 15 through Dec. 7 each year. You may be charged a Medicare-required late enrollment penalty on all your future premiums if you did not previously have other creditable coverage. Avoid this late fee by enrolling as soon as you are eligible.
Special Election Periods
There are certain circumstances that would qualify you for a Special Election Period, that is, enrollment outside of the Annual Election Period. For instance, if you move into the service area or involuntarily lose your current creditable coverage, you would be eligible for a Special Enrollment Period. Please contact Customer Service for more information.
Other Eligibility Requirements
You are eligible to enroll in RxBLUE PDP if you are entitled to Medicare benefits under Part A or enrolled in Part B and live in Louisiana. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third-party. You may be enrolled in only one Medicare prescription drug plan at a time. If you are enrolled in a Medicare Advantage coordinated care (HMO or PPO) plan or Medicare Advantage private fee-for-service plan that includes Medicare prescription drugs, you may not enroll in a Medicare prescription drug plan unless you disenroll from the HMO, PPO or Medicare Advantage private fee-for-service plan. If you are enrolled in a private fee-for-service plan that does not provide Medicare prescription drug coverage, a Medicare Advantage medical savings account or an 1876 Cost plan, you may enroll in a Medicare prescription drug plan.
Contract Termination and Member Rights
RxBLUE PDP has a contract with the Centers for Medicare & Medicaid Services (CMS) that may be renewed each year. However, either RxBLUE PDP or CMS can decide to end the contract at any time. If we leave the Medicare program or no longer offer prescription drug coverage in the service area where you live, we will notify you in writing. If either situation occurs, your membership in our Plan will end, and you will have to enroll in another Medicare Prescription Drug Plan or in a Medicare Advantage Plan with prescription drug coverage to continue receiving prescription drug benefits. More information regarding contract termination, as well, as your and our disenrollment rights and responsibilities can be found in the RxBLUE Basic PDP Evidence of Coverage or the RxBLUE Plus PDP Evidence of Coverage.
Blue Cross and Blue Shield of Louisiana is incorporated as Louisiana Health Service & Indemnity Company, a Medicare-approved Part D sponsor.
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