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Know Your Blue Medicare Advantage Options.

The first step in your Medicare journey is knowing your options. That’s why we created an easy-to-use tool that matches you with the plans available in your area.

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Know Your Blue Medicare Advantage Options.

Blue Medicare Advantage plans conveniently combine hospital, medical, prescription drug coverage, plus extra benefits, all-in-one plan. We offer two HMO plan options and two PPO plan options.

Essential Medicare Advantage Plan

Essential (PPO)

A $0 PPO plan that includes a national network of doctors and hospitals, in addition to prescription drug coverage and valuable extra benefits

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Access Medicare Advantage Plan

Access (PPO)

A PPO plan that offers flexibility to access providers that are in-network and out-of-network as long as they accept Medicare, as well as valuable extra benefits

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Complete Medicare Advantage Plan

Complete (HMO)

An HMO plan with hospital, medical and prescription drug coverage, a $0 monthly premium and no deductibles

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Plus Medicare Advantage Plan

Plus (HMO)

An HMO plan with hospital, medical and prescription drug coverage and a lower maximum out-of-pocket limit

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Supplemental Benefits

Prescription Drug Coverage Icon

Prescription Drug Coverage

A $0 prescription drug deductible, and a formulary with a broad number of Tier 1 and Tier 2 drugs.

SilverSneakers Fitness Membership Icon

SilverSneakers Fitness Membership

Save money and stay fit at more than 13,000 fitness centers at no extra cost.

Routine Hearing Exams and Hearing Aid Benefits Icon

Routine Hearing Exams and Hearing Aid Benefits

All of our plans include routine exams and hearing aid coverage.

Dental Coverage Icon

Dental Coverage

Choose how to use your benefits with plans that include preventive, routine and comprehensive care.

24-Hour Nurse Line Icon

24-Hour Nurse Line

Registered nurses are ready to take member calls 7 days a week, 365 days a year.

Acupuncture and Therapeutic Massage Coverage Icon

Acupuncture and Therapeutic Massage Coverage

For those with chronic pain, we offer plans with therapeutic massage or acupuncture.

Routine Vision Coverage Icon

Routine Vision Coverage

Use your vision benefit the way you want with our easy-to-use vision allowance PPO and HMO plans.

Transportation Icon

Transportation

Blue Medicare Advantage provides emergency and non-emergency medical transportation.

Benefits Comparison Chart

Blue Medicare Advantage Medical & Hospital Benefits

Essential (PPO)

Monthly Premium

$0 per month

Medical Deductible

$1,000***

Maximum Out-of-Pocket Limit*

In Network

$3,300 per month

Combined

$5,100 per month

Primary Care Provider Visits

In Network

$0 copay

Out of Network

45% coinsurance

Specialists Visits

In Network

$25 per month

Out of Network

45% coinsurance

Podiatrist Visits

In Network

$25 copay

Out of Network

45% coinsurance

Lab Services

In Network

$0 copay

Out of Network

45% coinsurance

Inpatient Hospital Care

In Network

$250 copay per day for days 1-4, $0 copay per day for days 5-90 $0 copay for additional days.

Out of Network

35% coinsurance

Outpatient Hospital Services

In Network

20% coinsurance

Out of Network

45% coinsurance

Outpatient Hospital Surgery

In Network

$250 copay

Out of Network

45% coinsurance

Urgent Care**

In Network

$50 copay

Out of Network

$50 copay

Emergency Care**

In Network

$120 copay

Out of Network

$120 copay

Ambulance (Ground & Air)

In Network

$270 copay

Out of Network

$270 copay

Access (PPO)

Monthly Premium

$49 per month

Medical Deductible

$0

Maximum Out-of-Pocket Limit*

In Network

$5,500 per month

Combined

$10,000 per month

Primary Care Provider Visits

In Network

$35 copay

Out of Network

20% coinsurance

Specialists Visits

In Network

$35 per month

Out of Network

20% coinsurance

Podiatrist Visits

In Network

$40 copay

Out of Network

20% coinsurance

Lab Services

In Network

$0 copay

Out of Network

20% coinsurance

Inpatient Hospital Care

In Network

$285 copay per day for days 1-6, $0 copay per day for days 7-90, $0 copay for additional days

Out of Network

20% coinsurance

Outpatient Hospital Services

In Network

20% coinsurance

Out of Network

20% coinsurance

Outpatient Hospital Surgery

In Network

$285 copay

Out of Network

20% coinsurance

Urgent Care**

In Network

$40 copay

Out of Network

$40 copay

Emergency Care**

In Network

$90 copay

Out of Network

$90 copay

Ambulance (Ground & Air)

In Network

$290 copay

Out of Network

$290 copay

Complete (HMO)

Monthly Premium

$0 per month

Medical Deductible

$0

Maximum Out-of-Pocket Limit*

$6,200 per year

Primary Care Provider Visits

$5 copay

Specialists Visits

$45 copay

Podiatrist Visits

$45 copay

Lab Services

$0 copay

Inpatient Hospital Care

$300 copay per day for days 1-5, $0 copay per day for days 6-90, $0 copay for additional days

Outpatient Hospital Services

20% coinsurance

Outpatient Hospital Surgery

$300 copay

Urgent Care**

$50 copay

Emergency Care**

$90 copay

Ambulance (Ground & Air)

$290 copay

Plus (HMO)

Monthly Premium

$34 per month

Medical Deductible

0

Maximum Out-of-Pocket Limit*

$4,800 per year

Primary Care Provider Visits

$0 copay

Specialists Visits

$35 copay

Podiatrist Visits

$40 copay

Lab Services

$0 copay

Inpatient Hospital Care

$285 copay per day for days 1-6, $0 copay per day for days 7-90, $0 copay for additional days

Outpatient Hospital Services

20% coinsurance

Outpatient Hospital Surgery

$285 copay

Urgent Care**

$40 copay

Emergency Care**

$90 copay

Ambulance (Ground & Air)

$290 copay

* Maximum out-of-pocket limit means you will never pay more than the above dollar amount per year for your Medicare-covered medical expenses, even if you have an unexpected illness or injury. If you reach this limit, you will no longer have to pay any copays or coinsurance.

** Blue Medicare Advantage provides worldwide emergency room and urgent care coverage.

*** In-network deductible applies to: Inpatient hospital, inpatient mental health, partial hospitalization, hospital observation, hospital outpatient, ambulatory surgery centers, home health, outpatient substance abuse, air and ground ambulance, dialysis.

Benefits Comparison Chart

Blue Medicare Advantage Prescription Drug Benefits

Blue Medicare Advantage includes Part D prescription drug coverage, so you do not need to purchase a separate plan. Without this benefit, you could end up paying all of your prescription drug costs.

We offer a 90-day mail order and retail drug benefit with a $0 copay for all Tier 1 and Tier 2 prescription drugs.

Essential (PPO)

Deductible

Network Pharmacies

$0

Preferred Generics

Network Pharmacies

$3 copay

Generics

Network Pharmacies

$15 copay

Preferred Brands

Network Pharmacies

$47 copay

Non-Preferred Brands

Network Pharmacies

$100 copay

Specialty Medications

Network Pharmacies

33% of the cost

Access (PPO)

Deductible

Network Pharmacies

$0

Preferred Generics

Network Pharmacies

$3 copay

Generics

Network Pharmacies

$12 copay

Preferred Brands

Network Pharmacies

$47 copay

Non-Preferred Brands

Network Pharmacies

$100 copay

Specialty Medications

Network Pharmacies

33% of the cost

Complete (HMO)

Deductible

Network Pharmacies

$0

Preferred Generics

Network Pharmacies

$3 copay

Generics

Network Pharmacies

$20 copay

Preferred Brands

Network Pharmacies

$47 copay

Non-Preferred Brands

Network Pharmacies

$100 copay

Specialty Medications

Network Pharmacies

33% of the cost

Plus (HMO)

Deductible

Network Pharmacies

$0

Preferred Generics

Network Pharmacies

$3 copay

Generics

Network Pharmacies

$12 copay

Preferred Brands

Network Pharmacies

$47 copay

Non-Preferred Brands

Network Pharmacies

$100 copay

Specialty Medications

Network Pharmacies

33% of the cost

Benefits Comparison Chart

Blue Medicare Advantage Valuable Extra Benefits

Essential (PPO)

SilverSneakers

Included at no additional cost

24-Hour Nurseline

Included at no additional cost

Vision

Routine Eye Exams

Diabetic Eye Exams

Eyewear Allowance

In network

$0 copay/one per year

Out of Network

50% coinsurance/one per year


In network

$0 copay/one per year

Out of Network

45% coinsurance


$350 allowance per year for eyeglass frames or contact lenses

Hearing

Routine Hearing Exams

Hearing Aids

In network

$0 copay/one per year

Out of Network

$45 copay/one per year


In network

$699–$999 copay per aid

Dental

Preventive and Comprehensive Visits

$750 annual allowance

Acupuncture & Therapeutic Massage
In network

12 visits per year/$20 copay per visit

Out of Network

12 visits per year/50% coinsurance


Maximum of 12 acupuncture and massage visits per year per member (in- and out-of-network combined).

Get the most out of your acupuncture benefit by using an American Specialty Health (ASH) in-network provider.

Over-the-Counter Item Allowance

$25/month

Worldwide Coverage

Worldwide emergency room and urgent care included

Non-Emergency Medical Transportation

12 one-way trips per year, limited to ground transportation (examples: medical appointments or prescription pick-up)


Transportation offered through ALC Solutions.

Post-Discharge Meals

Up to 14 fresh, locally prepared meals delivered to your home post inpatient facility stay.

Access (PPO)

SilverSneakers

Included at no additional cost

Vision

Routine Eye Exams

Diabetic Eye Exam

Eyewear Allowance

In network

$0 copay/one per year

Out of Network

50% coinsurance/one per year


In network

$0 copay/one per year

Out of Network

20% coinsurance


$300 allowance per year for eyeglass frames or contact lenses


Get the most out of your vision benefits by using an EyeMed Insight in-network provider. Members receive a $0 copay on routine exams when using the EyeMed Insight network.

Hearing

Routine Hearing Exams

Hearing Aids

$0 copay/one per year

$40 copay/one per year


Hearing Aids offered through TruHearing™ providers only. Advanced and Premium hearing aids only.

Dental

Preventive and Comprehensive Visits

$750 annual allowance

Acupuncture
In network

$20 copay per visit/20 visits per year

Out of Network

50% coinsurance/20 visits per year


Maximum of 12 acupuncture and massage visits per year per member (in- and out-of-network combined).

Get the most out of your acupuncture benefit by using an American Specialty Health (ASH) in-network provider.

Over-the-Counter Item Allowance

$25/month

Worldwide Coverage

Worldwide emergency room and urgent care included

Non-Emergency Medical Transportation

12 one-way trips per year, limited to ground transportation (examples: medical appointments or prescription pick-up)


Transportation offered through ALC Solutions.

Post-Discharge Meals

Up to 14 fresh, locally prepared meals delivered to your home post inpatient facility stay.

Complete (HMO)

SilverSneakers

Included at no additional cost

24-Hour Nurseline

Included at no additional cost

Vision

Routine Eye Exams

Diabetic Eye Exams

Eyewear Allowance

$0 copay/one per year

$0 copay/one per year

$150 eyewear allowance (eyewear or contact lenses)


Get the most out of your vision benefits by using an EyeMed Insight in-network provider. Members receive a $0 copay on routine exams when using the EyeMed Insight network.

Hearing

Routine Hearing Exams

Hearing Aids

$45 copay/one per year

$699-$999 copay 2 aids/year


Hearing Aids offered through TruHearing™ providers only. Advanced and Premium hearing aids only.

Dental

Preventive and Comprehensive Visits

$500 annual allowance


Preventive and comprehensive in-network dental services should be delivered by and are limited to DentaQuest network providers.

Acupuncture

$20 copay per visit/20 visits per year


Maximum of 12 acupuncture and massage visits per year per member (in- and out-of-network combined).

Get the most out of your acupuncture benefit by using an American Specialty Health (ASH) in-network provider.

Over-the-Counter Item Allowance

$25/month

Worldwide Coverage

Worldwide emergency room and urgent care included

Non-Emergency Medical Transportation

12 one-way trips per year, limited to ground transportation (examples: medical appointments or prescription pick-up)


Transportation offered through ALC Solutions.

Post-Discharge Meals

Up to 14 fresh, locally prepared meals delivered to your home post inpatient facility stay.

Plus (HMO)

SilverSneakers

Included at no additional cost

24-Hour Nurseline

Included at no additional cost

Vision

Routine Eye Exams

Diabetic Eye Exams

Eyewear Allowance

$0 copay/one per year

$0 copay/one per year

$300 allowance (eyewear or contact lenses)


Get the most out of your vision benefits by using an EyeMed Insight in-network provider. Members receive a $0 copay on routine exams when using the EyeMed Insight network.

Hearing

Routine Hearing Exams

Hearing Aids

$0 copay/one per year

$399-$699 copy per aid


Hearing Aids offered through TruHearing™ providers only. Advanced and Premium hearing aids only.

Dental

Preventive and Comprehensive Visits

$500 annual allowance


Preventive and comprehensive in-network dental services should be delivered by and are limited to DentaQuest network providers.

Acupuncture

$20 copay per visit/20 visits per year


Maximum of 12 acupuncture and massage visits per year per member (in- and out-of-network combined).

Get the most out of your acupuncture benefit by using an American Specialty Health (ASH) in-network provider.

Over-the-Counter Item Allowance

$25/month

Worldwide Coverage

Worldwide emergency room and urgent care included

Non-Emergency Medical Transportation

12 one-way trips per year, limited to ground transportation (examples: medical appointments or prescription pick-up)


Transportation offered through ALC Solutions.

Post-Discharge Meals

Up to 14 fresh, locally prepared meals delivered to your home post inpatient facility stay.

This information is not a complete description of benefits. Contact the plan for more information. You may also see our Summary of Benefits for more information. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. The Formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary. All Blue Medicare Advantage individual plans include Part D drug coverage. For HMO plan, members must use plan providers except in emergency or urgent care situations. If a member obtains routine care from an out-of-network provider without prior approval from Blue KC, neither Medicare nor Blue KC will be responsible for the costs. For PPO plan members, Blue Medicare Advantage (PPO) members are encouraged to use in-network plan providers. Out-of-network/non-contracted providers are under no obligation to treat members, except in emergency situations. For a decision about whether Blue KC will cover an out-of-network service, we encourage you or your provider to ask Blue KC for a pre-service organization determination before the service is received. Please call Blue Medicare Advantage Customer Service or refer to the Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Limitations, copayments, and restrictions may apply. Part D drug expenses are not covered under the maximum out-of-pocket limit. Our eyewear benefit is limited to one pair of eyeglass lenses and frames per year.

Anyone with Medicare Parts A and B living in the Missouri counties of Cass, Clay, Clinton, Jackson, Lafayette, Platte and Ray, or in the Kansas counties of Johnson and Wyandotte may apply to join Blue Medicare Advantage. Please note that enrollment may be limited to specific times of the year.

Medicare Coverage you can count on.

We’ve put our years of local knowledge to work building affordable, high-quality Medicare plans that meet the needs of our community across 32 counties.

  • Blue Medicare Advantage & Medicare Supplement

  • Medicare Supplement Only

  • Kansas City

Buchanan county residents eligible for Essential plan only.

Key Enrollment Dates

Initial Coverage Enrollment Period (IEP)

For those turning 65 (and therefore becoming eligible for Medicare for the first time), you may enroll from three months before to three months after you become eligible for Medicare.

Special Enrollment Period (SEP)

You may be able to enroll at a different time of the year. To learn more about special enrollment periods, visit http://www.medicare.gov.

Annual Enrollment Period (AEP)

From October 15 to December 7, you can switch to, drop, or join a different Medicare plan.

Open Enrollment Period

During Open Enrollment, Medicare beneficiaries are allowed to make “Like plan” changes from January 1 to March 31. Medicare beneficiaries can disenroll from their current plan and select a new plan with their existing carrier of competitor.

Ready to Enroll?

The right Medicare Advantage plan is right around the corner. And we’ll make it easy for you to sign up.

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