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

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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 Info

Plan Resources

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-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

* 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 Supply

33%
90-day Supply

N/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

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