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

4 Star Icon

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 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

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