Plan Overview
With this PPO product, you get hospital, medical and prescription drug coverage, plus extra benefits, all in one plan. Blue Medicare Advantage Access has a monthly premium of $60 and a combined in-network and out-of-network maximum out-of-pocket limit of $5,900. This means that if you get sick or need a high cost procedure, your copays are capped once you pay the $5,900. This plan offers great flexibility and freedom.
You won't need to choose a Primary Care Physician (PCP) or get a referral to see a specialist. By seeing preferred providers, you'll make the most of your benefits, but you also have the freedom to go out-of-network for care at a higher rate.
To join, you must be entitled to Medicare Part A, be enrolled in Medicare Part B, and live in the following counties in Kansas: Johnson and Wyandotte, and these counties in Missouri: Cass, Clay, Clinton, Jackson, Lafayette, Platte and Ray.
Advantages Include
- $60 monthly premium
- Part D prescription drug coverage
- $1,000 yearly dental benefit limit
- $300 annual eyewear benefit maximum
- Routine hearing exams and hearing aid coverage
- Monthly $25 over-the-counter items allowance
- SilverSneakers® fitness membership at no additional cost
- 24-hour Nurseline
- Non-emergency medical transportation
4-Star PPO plan options
We’re proud to announce that our PPO plans earned a 4 out of 5-Star rating from the Centers for Medicare & Medicaid Services (CMS). So, when it comes to quality and performance, Blue KC really shines.
More InfoPlan Resources
- Annual Notice of Change
- Evidence of Coverage
- Extra Help - Low Income Subsidy Information
- Summary of Benefits
- Comprehensive Prescription Drug Formulary Search – Blue Medicare Advantage
- Comprehensive Prescription Drug Formulary - Blue Medicare Advantage
- Drug Pricing Tool – Blue Medicare Advantage Access
- Blue Medicare Advantage Provider Search
- Other Plan Information
Plan Benefits
At-A-Glance
You must continue to pay Part B premium
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 Visit |
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-Network50% |
Lab Services |
In-Network$0 |
Out-of-Network50% |
X-Ray Services |
In-Network$0 |
Out-of-Network50% |
MRI/CT at physicians office or free standing |
In-Network$185 |
Out-of-Network50% |
MRI/CT at other facility |
In-Network$285 |
Out-of-Network50% |
Outpatient Services |
||
Outpatient Hospital (Non-Surgical) |
In-Network20% |
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-Network50% 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 |
* 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.
Prescription Drug Benefits
Annual Deductible |
$0 |
|
---|---|---|
Preferred Generics (Tier 1) |
30-day Supply$0 copay |
90-day Supply$0 copay |
Generics (Tier 2) |
30-day Supply$5 copay |
90-day Supply$0 copay |
Preferred Brands (Tier 3) |
30-day Supply$47 copay |
90-day Supply$141 copay |
Non-Preferred Drugs (Tier 4) |
30-day Supply$100 copay |
90-day Supply$300 copay |
Specialty Drugs (Tier 5) |
30-day Supply33% |
90-day SupplyN/A |
Gap Coverage |
T1 & T2 with same copay amounts & Tiers 3, 4 & 5 at 25% |
We offer a 90-day mail order and retail drug benefit with a $0 copay for all Tier 1 and Tier 2 prescription drugs.
This information is not a complete description of benefits.
Sheri Blue KC Medicare Expert
Ready to Enroll?
The right Medicare Advantage plan is right around the corner. And we’ll make it easy for you to sign up.
Enroll