Blue Medicare Advantage
Essential (PPO)
A $0 PPO plan that includes a national network of doctors and hospitals, in addition to prescription drug coverage and valuable extra benefits.
Blue Medicare Advantage
Essential (PPO)
A $0 PPO plan that includes a national network of doctors and hospitals, in addition to prescription drug coverage and valuable extra benefits.
Plan Overview
With this PPO product, you get hospital, medical and prescription drug coverage, plus extra benefits, all in one plan. Blue Medicare Advantage Essential has a $0 monthly premium and an in-network maximum out-of-pocket limit of $3,300. This means that if you get sick or need a high cost procedure, your copays are capped once you pay the $3,300. This plan includes a $1,000 deductible and 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 our service area. The Blue KC service area includes these counties in Kansas: Johnson and Wyandotte. And these counties in Missouri: Buchanan, Cass, Clay, Clinton, Jackson, Lafayette, Platte and Ray.
Advantages Include
- $0 monthly premium
- Low $3,300 annual out-of-pocket maximum
- Access to a nationwide network of doctors and hospitals
- Part D prescription drug coverage
- Large network of doctors and hospitals in Kansas City’s 10-county service area
- No referral requirements
- $750 yearly dental allowance
- $350 annual eyewear allowance
- Routine hearing exams and hearing aid coverage
- Monthly $25 over-the-counter items allowance
- SilverSneakers® fitness membership at no additional cost
- 24-hour Nurseline
- Member Rewards program - $25 gift cards for completing $0 cost-sharing services
- Acupuncture and therapeutic massage coverage
- Non-emergency medical transportation
- Post-discharge meals
Wondering which Medicare plan is right for you? We can help.
Medicare Plan Finder
We want to answer all of your Medicare needs. And that starts with a clear understanding of you and your life. Please take a moment to answer a few simple questions.
We can only recommend a Medicare plan if you are eligible for our Medicare plans.
You should be eligible for Medicare at the age of 65 if:
- You are a U.S. citizen or legal resident
- You have resided in the United States for a minimum of 5 years
- You have worked at least 10 years in Medicare-covered employment
- You live in the Blue KC service area, which includes 32 counties in Kansas and Missouri
Based on your selections, we recommend...
Blue Medicare advantage
Access (PPO)
$49
month
Advantages Include
- $49 monthly premium
- Access to a nationwide network of doctors and hospitals
- Part D prescription drug coverage
- Large network of doctors and hospitals in Kansas City’s 10-county service area
- No referral requirements
- $750 yearly dental allowance
- $300 annual eyewear allowance
- Routine hearing exams and hearing aid coverage
- Monthly $25 over-the-counter items allowance
- SilverSneakers® fitness membership at no additional cost
- 24-hour Nurseline
- Member Rewards program - $25 gift cards for completing $0 cost-sharing services
- Acupuncture coverage
- Non-emergency medical transportation
- Post-discharge meals
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Based on your selections, we recommend...
Blue Medicare advantage
Essential (PPO)
$0
month
Advantages Include
- $0 monthly premium
- Low $3,300 annual out-of-pocket maximum
- Access to a nationwide network of doctors and hospitals
- Part D prescription drug coverage
- Large network of doctors and hospitals in Kansas City’s 10-county service area
- No referral requirements
- $750 yearly dental allowance
- $350 annual eyewear allowance
- Routine hearing exams and hearing aid coverage
- Monthly $25 over-the-counter items allowance
- SilverSneakers® fitness membership at no additional cost
- 24-hour Nurseline
- Member Rewards program - $25 gift cards for completing $0 cost-sharing services
- Acupuncture and therapeutic massage coverage
- Non-emergency medical transportation
- Post-discharge meals
Share this plan with yourself (or someone else) to review later.
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Call to learn more about this plan.
Call 1-855-208-8246 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week
Based on your selections, we recommend...
Blue Medicare advantage
Complete (HMO)
$0
month
Advantages Include
- $0 monthly premium
- No yearly deductibles
- Medicare Part D prescription drug coverage
- Vast, local network of doctors and hospitals
- No referral requirements
- $500 yearly dental allowance
- $150 annual eyewear allowance
- Routine hearing exams and hearing aid coverage
- Monthly $25 over-the-counter items allowance
- SilverSneakers® fitness membership at no additional cost
- 24-hour Nurseline
- Member Rewards program - $25 gift cards for completing $0 cost-sharing services
- Acupuncture coverage
- Non-emergency medical transportation
- Post-discharge meals
Share this plan with yourself (or someone else) to review later.
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Success, we’ve emailed your Blue KC Medicare plan recommendation!
Call to learn more about this plan.
Call 1-855-208-8246 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week
Based on your selections, we recommend...
Blue Medicare advantage
Plus (HMO)
$34
month
Advantages Include
- $34 monthly premiums
- No yearly deductibles
- Medicare Part D prescription drug coverage
- Vast, local network of doctors and hospitals
- No referral requirements
- $500 yearly dental allowance
- $300 annual eyewear allowance
- Routine hearing exams and hearing aid coverage
- Monthly $25 over-the-counter items allowance
- SilverSneakers® fitness membership at no additional cost
- 24-hour Nurseline
- Member Rewards program - $25 gift cards for completing $0 cost-sharing services
- Acupuncture coverage
- Non-emergency medical transportation
- Post-discharge meals
Share this plan with yourself (or someone else) to review later.
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Call to learn more about this plan.
Call 1-855-208-8246 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week
Based on your selections, we recommend...
Blue Medicare advantage
Medicare Supplement (MEDIGAP)
starting at
$130
month*
Medicare Supplement (Medigap) insurance can help pay some of the healthcare costs that Original Medicare doesn't cover, like copayments, coinsurance and deductibles. Benefits may vary depending on whether you live in Kansas or Missouri.
Advantages Include
- Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end
- Medical expenses: Part B coinsurance (generally 20% of Medicare-approved expenses) or copayments for hospital outpatient services. Certain plans require you to pay a portion of Part B coinsurance or copayments.
- Foreign travel: Emergency care services needed for trips outside the U.S.
- Hospice: Part A coinsurance
*Quote based on state, gender, product availability and underwriting.
These policies have limitations. For costs and complete details of the coverage, call us today.
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Call to learn more about this plan.
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You've Got Questions. We've Got Answers.
Share your contact information, and we’ll reach out.**
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Medical & Hospital Benefits
You must continue to pay Part B premium
Monthly Premium |
$0 per month |
|
---|---|---|
Medical Deductible |
$1,000*** |
|
Maximum Out-of-Pocket Limit* |
In Network$3,300 per year |
Combined$5,100 per year |
Primary Care Provider Visits |
In Network$0 copay |
Out of Network45% coinsurance |
Specialist Visits |
In Network$25 copay |
Out of Network45% coinsurance |
Podiatrist Visits |
In Network$25 copay |
Out of Network45% coinsurance |
Lab Services |
In Network$0 copay |
Out of Network45% coinsurance |
Inpatient Hospital Care |
In Network$250 copay per day for days 1-4, $0 copay per day for days 5-90, $0 copay for additional days. |
Out of Network35% coinsurance |
Outpatient Hospital Services |
In Network20% coinsurance |
Out of Network45% coinsurance |
Outpatient Hospital Surgery |
In Network$250 copay |
Out of Network45% coinsurance |
Urgent Care** |
In Network$50 copay |
Out of Network$50 copay |
Emergency Care** |
In Network$120 copay |
Out of Network$120 copay |
Ambulance (Ground & Air) |
In Network$270 copay |
Out of Network$270 copay |
* Maximum out-of-pocket limit means you will never pay more than the above dollar amount per year for your Medicare-covered medical expenses, even if you have an unexpected illness or injury. If you reach this limit, you will no longer have to pay any copays or coinsurance.
** Blue Medicare Advantage provides worldwide emergency room and urgent care coverage.
*** In-network deductible applies to: Inpatient hospital, inpatient mental health, partial hospitalization, hospital observation, hospital outpatient, ambulatory surgery centers, home health, outpatient substance abuse, air and ground ambulance, dialysis.
Prescription Drug Benefits
Deductible |
Network Pharmacies$0 |
---|---|
Preferred Generics |
Network Pharmacies$3 copay |
Generics |
Network Pharmacies$15 copay |
Preferred Brands |
Network Pharmacies$47 copay |
Non-Preferred Brands |
Network Pharmacies$100 copay |
Specialty Medications |
Network Pharmacies33% of the cost |
We offer a 90-day mail order and retail drug benefit with a $0 copay for all Tier 1 and Tier 2 prescription drugs.
Valuable Extra Benefits
SilverSneakers |
Included at no additional cost |
|
---|---|---|
24-Hour Nurseline |
Included at no additional cost |
|
Vision |
||
Routine Eye Exams |
In Network$0 copay/one per year |
Out of Network50% coinsurance/one per year |
Diabetic Eye Exams |
In Network$0 copay/one per year |
Out of Network45% coinsurance |
Eyewear Allowance |
$350 allowance per year for eyeglass frames or contact lenses |
|
Get the most out of your vision benefits by using an EyeMed Insight in-network provider. Members receive a $0 copay on routine exams when using the EyeMed Insight network. | ||
Hearing |
||
Routine Hearing Exams |
In Network$0 copay/one per year |
Out of Network$45 copay/one per year |
Hearing Aids |
In Network$699–$999 copay per aid |
|
Hearing aids offered through TruHearing™ providers only. Advanced and Premium hearing aids only. | ||
DentalPreventive and Comprehensive Visits |
$750 allowance per year |
|
Acupuncture & Therapeutic Massage |
In Network12 visits per year/$20 copay per visit |
Out of Network12 visits per year/50% coinsurance |
Maximum of 12 acupuncture and massage visits per year per member (in- and out-of-network combined). |
||
Over-the-Counter Items Allowance |
$25/month |
|
Visitor/Travel Benefit |
Blue Medicare Advantage (PPO) plans include a Visitor/Travel Benefit through the Blue Cross Blue Shield MA PPO network sharing arrangement. The network sharing benefit allows Blue Medicare Advantage (PPO) members to obtain in-network benefits from a contracted Blue Cross Blue Shield Medicare Advantage PPO provider when traveling or living outside of the Blue Medicare Advantage 10-county service area. Blue Medicare Advantage (PPO) shared networks are available in 39 states and one territory: Alabama, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Missouri, Montana, North Carolina, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oregon, Oklahoma, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, and West Virginia. For some of the states listed, MA PPO networks are only available in portions of the state. |
|
Non-Emergency Medical Transportation |
12 one-way trips per year, limited to ground transportation (examples: medical appointments or prescription pick-up) |
|
Transportation offered through ALC Solutions. | ||
Post-Discharge Meals |
Up to 14 fresh, locally prepared meals delivered to your home post inpatient facility stay. |
|
Member Rewards Program |
The Member Rewards Program is available to all Blue Medicare Advantage members. The program rewards members with $25 gift cards to popular retailers for completing varying activities. Members can earn a $25 gift card for the following $0 cost-sharing services:
The maximum gift card reward per member is $50 per plan year. |
Plan Resources
- Annual Notice of Change
- Evidence of Coverage
- Extra Help - Low Income Subsidy Information
- Summary of Benefits
- Comprehensive Prescription Drug Formulary – Blue Medicare Advantage PPO Plan
- Prescription Drug Formulary Change Notice – Blue Medicare Advantage PPO Plan
- Blue Medicare Advantage (PPO) Essential Provider Directory
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.
Call one of our certified Blue Medicare Advantage experts or enroll online using our secure enrollment system today.
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