Plan Overview

With this HMO product, you get freedom of choice (no referrals) and a focus on helping you navigate your health care choices so that you get the right care, at the right time. This plan includes hospital, medical and prescription drug coverage, plus extra benefits, all in one plan. Blue Medicare Advantage Complete has a $0 monthly premium, no deductibles and an in-network maximum out-of-pocket limit of $6,200. You'll be required to get most of your care from an in-network provider. You'll also be asked to choose a primary care physician who will provide your basic healthcare services.

Blue Advantage Complete includes an option to buy additional eyewear and comprehensive dental services for $25 per month.

To join, you must be entitled to Medicare Part A, be enrolled in Medicare Part B, and live in these counties in Kansas: Johnson and Wyandotte, and these counties in Missouri: Cass, Clay, Clinton, Jackson, Lafayette, Platte and Ray.

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Advantages Include

  • $0 monthly premium
  • No yearly deductibles
  • Medicare Part D prescription drug coverage
  • Preventive dental services
  • Annual routine eye exam
  • 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

Plan Resources

Plan Benefits
At-A-Glance

You must continue to pay Part B premium

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 Visit
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%
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

* 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

$3 copay
90-day Supply

$0 copay
Generics (Tier 2)
30-day Supply

$10 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

Original Medicare Standard: 25% for all Tiers

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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