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.
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
- 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 Complete
- Blue Medicare Advantage Provider Search
- Other Plan Information
Plan Benefits
At-A-Glance
You must continue to pay Part B premium
Total Premium |
$0 Optional supplemental benefit for Dental and Vision: |
---|---|
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-Network20% |
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 $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 Supply33% |
90-day SupplyN/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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