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Benefits Comparison Chart
Blue Medicare Advantage Plans At-A-Glance
|
You must continue to pay Part B premium |
Essential(PPO) |
Access(PPO) |
Flex(no Part D)(PPO) |
Complete(HMO) |
Plus(HMO) |
Spira Care(HMO) |
|---|---|---|---|---|---|---|
| Counties Covered | ||||||
| Counties Covered |
Buchanan, MO |
Cass, MO |
Cass, MO |
Cass, MO |
Cass, MO |
Johnson, KS |
| Total Premium | ||||||
| Total Premium |
$0 |
$60 |
$0 |
$0 Optional supplemental benefit for Dental and Vision: |
$45 |
$0 Optional supplemental benefit for Dental and Vision: |
| Visitor Travel | ||||||
| Visitor Travel | Covered |
Covered |
Not Applicable |
Not Covered |
Not Covered |
Not Covered |
| Plan Deductible | ||||||
| Plan Deductible | $500* |
$0 |
$0 |
$0 |
$0 |
$0 |
| Maximum Out of Pocket (MOOP) | ||||||
| Maximum Out of Pocket (MOOP) | $4,000 |
$5,900 |
$4,000 |
$6,200 |
$5,200 |
$4,800 |
Inpatient Services |
||||||
| Inpatient Hospital - Acute | ||||||
| Inpatient Hospital - Acute |
In-Network$250, Days 1-5; $0, Days 6-90** Out-of-Network45% per stay |
In-Network$285, Days 1-5; $0, Days 6-90** Out-of-Network$500, Days 1-5; $0, Days 6-90 |
In-Network$285, Days 1-6; $0, Days 7-90** Out-of-Network$285, Days 1-6; $0, Days 7-90** |
In-Network$325, Days 1-5; $0, Days 6-90** |
In-Network$285, Days 1-6; $0, Days 7-90** |
In-Network$300, Days 1-5; $0, Days 6-90** |
| Skilled Nursing Facility | ||||||
| Skilled Nursing Facility |
In-Network$0, Days 1-20; $184, Days 21-100 Out-of-Network45%, Days 1-100 |
In-Network$0, Days 1-20; $184, Days 21-100 Out-of-Network$0, Days 1-20; $184, Days 21-100 |
In-Network$0, Days 1-20; $184, Days 21-100 Out-of-Network$0, Days 1-20; $184, Days 21-100 |
In-Network$0, Days 1-20; $184, Days 21-100 |
In-Network$0, Days 1-20; $184, Days 21-100 |
In-Network$0, Days 1-20; $184, Days 21-100 |
Emergency Care/Urgent Care |
||||||
| Emergency Care (Worldwide) | ||||||
| Emergency Care (Worldwide) |
In-Network$90 Out-of-Network$90 |
In-Network$90 Out-of-Network$90 |
In-Network$90 Out-of-Network$90 |
In-Network$90 |
In-Network$90 |
In-Network$90 |
| Urgently Needed Care (Worldwide) | ||||||
| Urgently Needed Care (Worldwide) |
In-Network$50 Out-of-Network$50 |
In-Network$50 Out-of-Network$50 |
In-Network$50 Out-of-Network$50 |
In-Network$50 |
In-Network$40 |
In-Network$50 |
| Ambulance Services (Worldwide *NEW* 2021) | ||||||
| Ambulance Services (Worldwide *NEW* 2021) |
In-Network$300 Out-of-Network$300 |
In-Network$285 Out-of-Network$285 |
In-Network$285 Out-of-Network$285 |
In-Network$325 |
In-Network$285 |
In-Network$300 |
Professional Services |
||||||
| PCP Visit | ||||||
| PCP Visit |
In-Network$5 Out-of-Network45% |
In-Network$5 Out-of-Network$10 |
In-Network$5 Out-of-Network$5 |
In-Network$5 |
In-Network$5 |
In-Network$0 |
| Specialist Visit | ||||||
| Specialist Visit |
In-Network$25 Out-of-Network45% |
In-Network$35 Out-of-Network$70 |
In-Network$20 Out-of-Network$20 |
In-Network$45 |
In-Network$40 |
In-Network$30 |
| Podiatry & Routine Foot Care 6/year | ||||||
| Podiatry & Routine Foot Care 6/year |
In-Network$25 Out-of-Network45% |
In-Network$35 Out-of-Network$70 |
In-Network$20 Out-of-Network$20 |
In-Network$45 |
In-Network$45 |
In-Network$30 |
Diagnostic Testing Services |
||||||
| Other Diagnostic Procedures/Tests | ||||||
| Other Diagnostic Procedures/Tests |
In-Network$0 Out-of-Network45% |
In-Network$0 Out-of-Network50% |
In-Network$0 Out-of-Network$0 |
In-Network$0 |
In-Network$0 |
In-Network$0 |
| Lab Services | ||||||
| Lab Services |
In-Network$0 Out-of-Network45% |
In-Network$0 Out-of-Network50% |
In-Network$0 Out-of-Network$0 |
In-Network$0 |
In-Network$0 |
In-Network$0 |
| X-Ray Services | ||||||
| X-Ray Services |
In-Network$0 Out-of-Network45% |
In-Network$0 Out-of-Network50% |
In-Network$0 Out-of-Network$0 |
In-Network$0 |
In-Network$0 |
In-Network$0 |
| MRI/CT at physicians office or free standing | ||||||
| MRI/CT at physicians office or free standing |
In-Network$150 Out-of-Network45% |
In-Network$185 Out-of-Network50% |
In-Network$185 Out-of-Network20% |
In-Network$225 |
In-Network$185 |
In-Network$200 |
| MRI/CT at other facility | ||||||
| MRI/CT at other facility |
In-Network$250 Out-of-Network45% |
In-Network$285 Out-of-Network50% |
In-Network$285 Out-of-Network20% |
In-Network$325 |
In-Network$285 |
In-Network$300 |
Outpatient Services |
||||||
| Outpatient Hospital (Non-Surgical) | ||||||
| Outpatient Hospital (Non-Surgical) |
In-Network20% Out-of-Network45% |
In-Network20% Out-of-Network$500 |
In-Network20% Out-of-Network20% |
In-Network20% |
In-Network20% |
In-Network20% |
| Observation | ||||||
| Observation |
In-Network$250 Out-of-Network45% |
In-Network$285 Out-of-Network$500 |
In-Network$285 Out-of-Network$285 |
In-NetworkNot Applicable |
In-NetworkNot Applicable |
In-NetworkNot Applicable |
| Surgery (ASC or Outpatient Hospital) | ||||||
| Surgery (ASC or Outpatient Hospital) |
In-Network$250 Out-of-Network45% |
In-Network$285 Out-of-Network$500 |
In-Network$285 Out-of-Network$285 |
In-Network$325 |
In-Network$285 |
In-Network$300 |
Supplemental Services |
||||||
| Dental Services (DentaQuest) 1 | ||||||
| Dental Services (DentaQuest) 1 |
In-Network$0 Copay, 2 Exams/Cleaning, 1 X-ray/Fluoride; 50% Coinsurance for Comprehensive; Out-of-Network45% Coinsurance, 2 Exams/Cleaning, 1 X-ray/Fluoride; 45% Coinsurance for Comprehensive; $1,000 Benefit Maximum Combined |
In-Network$0 Copay, 2 Exams/Cleaning, 1 X-ray/Fluoride; 50% Coinsurance for Comprehensive; Out-of-Network50% Coinsurance, 2 Exams/Cleaning, 1 X-ray/Fluoride; 50% Coinsurance for Comprehensive; $1,000 Benefit Maximum Combined |
$0 Copay, 2 Exams/Cleaning, 1 X-ray/Fluoride; 50% Coinsurance for Comprehensive; $1,000 Benefit Maximum Combined |
$0 Copay, 2 Exams/Cleaning, 1 X-ray/Fluoride Optional Supplemental benefit:20%-50% Coinsurance for Comprehensive $25/Additional Monthly premium buy-up for Dental and Vision. |
$0 Copay, 2 Exams/Cleaning, 1 X-ray/Fluoride; 50% Coinsurance for Comprehensive; $1,000 Benefit Maximum Combined |
$0 Copay, 2 Exams/Cleaning, 1 X-ray/Fluoride Optional Supplemental benefit:20%-50% Coinsurance for Comprehensive $25/Additional Monthly premium buy-up for Dental and Vision. |
| Vision Eyewear Benefits (EyeMed) 2 | ||||||
| Vision Eyewear Benefits (EyeMed) 2 |
$300 Every Year |
$300 Every Year |
$300 Every Year |
Optional Supplemental benefit:Our plan pays up to $250 every year for eyewear. $25/Additional Monthly premium buy-up for Dental and Vision. |
$250 Every Year |
Optional Supplemental benefit:Our plan pays up to $250 every year for eyewear. $25/Additional Monthly premium buy-up for Dental and Vision. |
| Hearing Aid (TruHearing) | ||||||
| Hearing Aid (TruHearing) |
$699-$999 |
$399-$699 |
$699-$999 |
$699-$999 |
$399-$699 |
$399-$699 |
Essential (PPO)
Counties Covered
Buchanan, MO
Cass, MO
Clay, MO
Clinton, MO
Jackson, MO
Johnson, KS
Lafayette, MO
Platte, MO
Ray, MO
Wyandotte, KS
Total Premium
$0
Visitor Travel
Covered
Plan Deductible
$500*
Maximum Out of Pocket (MOOP)
$4,000
Inpatient Services
Inpatient Hospital - Acute
In-Network
$250, Days 1-5; $0, Days 6-90**
Out-of-Network
45% per stay
Skilled Nursing Facility
In-Network
$0, Days 1-20; $184, Days 21-100
Out-of-Network
45%, Days 1-100
Emergency Care/Urgent Care
Emergency Care (Worldwide)
In-Network
$90
Out-of-Network
$90
Urgently Needed Care (Worldwide)
In-Network
$50
Out-of-Network
$50
Ambulance Services (Worldwide *NEW* 2021)
In-Network
$300
Out-of-Network
$300
Professional Services
PCP Visit
In-Network
$5
Out-of-Network
45%
Specialist Visits
In-Network
$25
Out-of-Network
45%
Podiatry & Routine Foot Care 6/year
In-Network
$25
Out-of-Network
45%
Diagnostic Testing Services
Other Diagnostic Procedures/Tests
In-Network
$0
Out-of-Network
45%
Lab Services
In-Network
$0
Out-of-Network
45%
X-Ray Services
In-Network
$0
Out-of-Network
45%
MRI/CT at physicians office or free standing
In-Network
$150
Out-of-Network
45%
MRI/CT at other facility
In-Network
$250
Out-of-Network
45%
Outpatient Services
Outpatient Hospital (Non-Surgical)
In-Network
20%
Out-of-Network
45%
Observation
In-Network
$250
Out-of-Network
45%
Surgery (ASC or Outpatient Hospital)
In-Network
$250
Out-of-Network
45%
Supplemental Services
Dental Services (DentaQuest) 1
In-Network
$0 Copay, 2 Exams/Cleaning, 1 X-ray/Fluoride; 50% Coinsurance for Comprehensive;
Out-of-Network
45% Coinsurance, 2 Exams/Cleaning, 1 X-ray/Fluoride; 45% Coinsurance for Comprehensive;
$1,000 Benefit Maximum Combined
Vision Eyewear Benefits (EyeMed) 2
$300 Every Year
Hearing Aid (TruHearing)
$699-$999
Access (PPO)
Counties Covered
Cass, MO
Clay, MO
Clinton, MO
Jackson, MO
Johnson, KS
Lafayette, MO
Platte, MO
Ray, MO
Wyandotte, KS
Total Premium
$60
Visitor Travel
Covered
Plan Deductible
$0
Maximum Out of Pocket (MOOP)
$5,900
Inpatient Services
Inpatient Hospital - Acute
In-Network
$285, Days 1-5; $0, Days 6-90**
Out-of-Network
$500, Days 1-5; $0, Days 6-90
Skilled Nursing Facility
In-Network
$0, Days 1-20; $184, Days 21-100
Out-of-Network
$0, Days 1-20; $184, Days 21-100
Emergency Care/Urgent Care
Emergency Care (Worldwide)
In-Network
$90
Out-of-Network
$90
Urgently Needed Care (Worldwide)
In-Network
$50
Out-of-Network
$50
Ambulance Services (Worldwide *NEW* 2021)
In-Network
$285
Out-of-Network
$285
Professional Services
PCP Visit
In-Network
$5
Out-of-Network
$10
Specialist Visits
In-Network
$35
Out-of-Network
$70
Podiatry & Routine Foot Care 6/year
In-Network
$35
Out-of-Network
$70
Diagnostic Testing Services
Other Diagnostic Procedures/Tests
In-Network
$0
Out-of-Network
50%
Lab Services
In-Network
$0
Out-of-Network
50%
X-Ray Services
In-Network
$0
Out-of-Network
50%
MRI/CT at physicians office or free standing
In-Network
$185
Out-of-Network
50%
MRI/CT at other facility
In-Network
$285
Out-of-Network
50%
Outpatient Services
Outpatient Hospital (Non-Surgical)
In-Network
20%
Out-of-Network
$500
Observation
In-Network
$285
Out-of-Network
$500
Surgery (ASC or Outpatient Hospital)
In-Network
$285
Out-of-Network
$500
Supplemental Services
Dental Services (DentaQuest) 1
In-Network
$0 Copay, 2 Exams/Cleaning, 1 X-ray/Fluoride; 50% Coinsurance for Comprehensive;
Out-of-Network
50% Coinsurance, 2 Exams/Cleaning, 1 X-ray/Fluoride; 50% Coinsurance for Comprehensive;
$1,000 Benefit Maximum Combined
Vision Eyewear Benefits (EyeMed) 2
$300 Every Year
Hearing Aid (TruHearing)
$399-$699
Flex (PPO)
Counties Covered
Cass, MO
Clay, MO
Clinton, MO
Jackson, MO
Johnson, KS
Lafayette, MO
Platte, MO
Ray, MO
Wyandotte, KS
Total Premium
$0
Visitor Travel
Not Applicable
Plan Deductible
$0
Maximum Out of Pocket (MOOP)
$4,000
Inpatient Services
Inpatient Hospital - Acute
In-Network
$285, Days 1-6; $0, Days 7-90**
Out-of-Network
$285, Days 1-6; $0, Days 7-90**
Skilled Nursing Facility
In-Network
$0, Days 1-20; $184, Days 21-100
Out-of-Network
$0, Days 1-20; $184, Days 21-100
Emergency Care/Urgent Care
Emergency Care (Worldwide)
In-Network
$90
Out-of-Network
$90
Urgently Needed Care (Worldwide)
In-Network
$50
Out-of-Network
$50
Ambulance Services (Worldwide *NEW* 2021)
In-Network
$285
Out-of-Network
$285
Professional Services
PCP Visit
In-Network
$5
Out-of-Network
$5
Specialist Visits
In-Network
$20
Out-of-Network
$20
Podiatry & Routine Foot Care 6/year
In-Network
$20
Out-of-Network
$20
Diagnostic Testing Services
Other Diagnostic Procedures/Tests
In-Network
$0
Out-of-Network
$0
Lab Services
In-Network
$0
Out-of-Network
$0
X-Ray Services
In-Network
$0
Out-of-Network
$0
MRI/CT at physicians office or free standing
In-Network
$185
Out-of-Network
20%
MRI/CT at other facility
In-Network
$285
Out-of-Network
20%
Outpatient Services
Outpatient Hospital (Non-Surgical)
In-Network
20%
Out-of-Network
20%
Observation
In-Network
$285
Out-of-Network
$285
Surgery (ASC or Outpatient Hospital)
In-Network
$285
Out-of-Network
$285
Supplemental Services
Dental Services (DentaQuest) 1
$0 Copay, 2 Exams/Cleaning, 1 X-ray/Fluoride; 50% Coinsurance for Comprehensive;
$1,000 Benefit Maximum Combined
Vision Eyewear Benefits (EyeMed) 2
$300 Every Year
Hearing Aid (TruHearing)
$699-$999
Complete (HMO)
Counties Covered
Cass, MO
Clay, MO
Clinton, MO
Jackson, MO
Johnson, KS
Lafayette, MO
Platte, MO
Ray, MO
Wyandotte, KS
Total Premium
$0
Optional supplemental benefit for Dental and Vision:
Additional $25 per month.
Visitor Travel
Not Covered
Plan Deductible
$0
Maximum Out of Pocket (MOOP)
$6,200
Inpatient Services
Inpatient Hospital - Acute
In-Network
$325, Days 1-5; $0, Days 6-90**
Skilled Nursing Facility
In-Network
$0, Days 1-20; $184, Days 21-100
Emergency Care/Urgent Care
Emergency Care (Worldwide)
In-Network
$90
Urgently Needed Care (Worldwide)
In-Network
$50
Ambulance Services (Worldwide *NEW* 2021)
In-Network
$325
Professional Services
PCP Visit
In-Network
$5
Specialist Visits
In-Network
$45
Podiatry & Routine Foot Care 6/year
In-Network
$45
Diagnostic Testing Services
Other Diagnostic Procedures/Tests
In-Network
$0
Lab Services
In-Network
$0
X-Ray Services
In-Network
$0
MRI/CT at physicians office or free standing
In-Network
$225
MRI/CT at other facility
In-Network
$325
Outpatient Services
Outpatient Hospital (Non-Surgical)
In-Network
20%
Observation
In-Network
Not Applicable
Surgery (ASC or Outpatient Hospital)
In-Network
$325
Supplemental Services
Dental Services (DentaQuest) 1
$0 Copay, 2 Exams/Cleaning, 1 X-ray/Fluoride
Optional Supplemental benefit:
20%-50% Coinsurance for Comprehensive
Our plan pays up to $2,000 every year for Comprehensive Dental Services.
$25/Additional Monthly premium buy-up for Dental and Vision.
Vision Eyewear Benefits (EyeMed) 2
Optional Supplemental benefit:
Our plan pays up to $250 every year for eyewear.
$25/Additional Monthly premium buy-up for Dental and Vision.
Hearing Aid (TruHearing)
$699-$999
Plus (HMO)
Counties Covered
Cass, MO
Clay, MO
Clinton, MO
Jackson, MO
Johnson, KS
Lafayette, MO
Platte, MO
Ray, MO
Wyandotte, KS
Total Premium
$45
Visitor Travel
Not Covered
Plan Deductible
$0
Maximum Out of Pocket (MOOP)
$5,200
Inpatient Services
Inpatient Hospital - Acute
In-Network
$285, Days 1-6; $0, Days 7-90**
Skilled Nursing Facility
In-Network
$0, Days 1-20; $184, Days 21-100
Emergency Care/Urgent Care
Emergency Care (Worldwide)
In-Network
$90
Urgently Needed Care (Worldwide)
In-Network
$40
Ambulance Services (Worldwide *NEW* 2021)
In-Network
$285
Professional Services
PCP Visit
In-Network
$5
Specialist Visits
In-Network
$40
Podiatry & Routine Foot Care 6/year
In-Network
$45
Diagnostic Testing Services
Other Diagnostic Procedures/Tests
In-Network
$0
Lab Services
In-Network
$0
X-Ray Services
In-Network
$0
MRI/CT at physicians office or free standing
In-Network
$185
MRI/CT at other facility
In-Network
$285
Outpatient Services
Outpatient Hospital (Non-Surgical)
In-Network
20%
Observation
In-Network
Not Applicable
Surgery (ASC or Outpatient Hospital)
In-Network
$285
Supplemental Services
Dental Services (DentaQuest) 1
$0 Copay, 2 Exams/Cleaning, 1 X-ray/Fluoride; 50% Coinsurance for Comprehensive;
$1,000 Benefit Maximum Combined
Vision Eyewear Benefits (EyeMed) 2
$250 Every Year
Hearing Aid (TruHearing)
$399-$699
Spira Care (HMO)
Counties Covered
Johnson, KS
Wyandotte, KS
Total Premium
$0
Optional supplemental benefit for Dental and Vision:
Additional $25 per month.
Visitor Travel
Not Covered
Plan Deductible
$0
Maximum Out of Pocket (MOOP)
$4,800
Inpatient Services
Inpatient Hospital - Acute
In-Network
$300, Days 1-5; $0, Days 6-90**
Skilled Nursing Facility
In-Network
$0, Days 1-20; $184, Days 21-100
Emergency Care/Urgent Care
Emergency Care (Worldwide)
In-Network
$90
Urgently Needed Care (Worldwide)
In-Network
$50
Ambulance Services (Worldwide *NEW* 2021)
In-Network
$300
Professional Services
PCP Visit
In-Network
$0
Specialist Visits
In-Network
$30
Podiatry & Routine Foot Care 6/year
In-Network
$30
Diagnostic Testing Services
Other Diagnostic Procedures/Tests
In-Network
$0
Lab Services
In-Network
$0
X-Ray Services
In-Network
$0
MRI/CT at physicians office or free standing
In-Network
$200
MRI/CT at other facility
In-Network
$300
Outpatient Services
Outpatient Hospital (Non-Surgical)
In-Network
20%
Observation
In-Network
Not Applicable
Surgery (ASC or Outpatient Hospital)
In-Network
$300
Supplemental Services
Dental Services (DentaQuest) 1
$0 Copay, 2 Exams/Cleaning, 1 X-ray/Fluoride
Optional Supplemental benefit:
20%-50% Coinsurance for Comprehensive
Our plan pays up to $2,000 every year for Comprehensive Dental Services.
$25/Additional Monthly premium buy-up for Dental and Vision.
Vision Eyewear Benefits (EyeMed) 2
Optional Supplemental benefit:
Our plan pays up to $250 every year for eyewear.
$25/Additional Monthly premium buy-up for Dental and Vision.
Hearing Aid (TruHearing)
$399-$699
* 2021 Deductible applies to these In-network services: dialysis services, inpatient acute & psychiatric hospital, partial hospitalization, outpatient hospital services, observation services, and ambulatory surgical center (ASC) services. All out-of-network Medicare-covered services, except zero-dollar preventive services, apply to the deductible.
** After 90 days, our plan covers an unlimited number of additional days for an inpatient hospital stay at $0 copay.
1 Member is responsible for charges over the Dental Benefit Maximum.
2 Member is responsible for charges over the Eyewear Benefit Maximum.
This information is not a complete description of benefits.
Andrea Blue KC Medicare Expert
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