S5715-013: Blue Cross MedicareRx Basic – 2025 Medicare Part D Plan
S5715-013: Blue Cross MedicareRx Basic – 2025 Medicare Part D Plan
CMS 5-Star Rating: (3.0 out of 5 stars*)
2025 Blue Cross MedicareRx Basic Part D plan (S5715-013) is a CMS-listed Prescription Drug Plan (PDP) with published data on coverage and costs.
* The Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
| Part D Plan Overview | |
|---|---|
| Part D Plan ID: | S5715-013 |
| Plan Year: | 2025 |
| Total Part D Premium: | $95.40 |
| Annual Deductible: | $590.00 |
| Part D Benefit Type: | Basic |
| No Deductible Drug Tier: | Not Applicable |
| Low Income Subsidy: | Yes |
| Insured By: | Blue Cross and Blue Shield of IL, NM, OK, TX |
Plan Costs
Premium Details
| Basic Part D Premium: | $95.40 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $95.40 |
| Low Income Premium Subsidy: | $15.83 |
| Low Income Premium Subsidy CMS Pays: | $15.80 |
| Low Income Subsidy Premium: | $79.60 |
Did you know? The Extra Help program (LIS) can reduce premiums, deductibles, and copays for eligible Medicare Part D enrollees in New Mexico. Check eligibility at the Social Security Extra Help page.
Deductible
The deductible for the 2025 Blue Cross MedicareRx Basic PDP (S5715-013) is $590.00, based on the CMS Landscape dataset.
Out-of-Pocket Costs
| Drug Tier | Retail | Mail Order | |
|---|---|---|---|
| Preferred Generic | $1.00 | $10.00 | |
| Generic | $5.00 | $15.00 | |
| Preferred Brand | 18.00% | 19.00% | |
| Non-Preferred Drug | 48.00% | 48.00% | |
| Specialty Tier | 25.00% | 25.00% | |
| *Deductible does not apply. | |||
CMS 5-Star Rating Data for Plan S5715-013
The CMS 5-star system measures Medicare Part D plan quality, including service, member experience, and drug safety. A 5-star rating is the highest score.
| 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 |
Contact Blue Cross and Blue Shield of IL, NM, OK, TX
| Website: | Blue Cross and Blue Shield of IL, NM, OK, TX Plan Page |
|---|---|
| Formulary: | Blue Cross and Blue Shield of IL, NM, OK, TX Formulary Page |
| Pharmacy: | Blue Cross and Blue Shield of IL, NM, OK, TX Pharmacy Page |
| Prospective Part D Members: | (877)213-1817 |
| Prospective Part D TTY Users: | 711 |
Last update: .