Blue Medicare Advantage Essential (PPO)

Plan Overview

Blue Medicare Advantage Essential is our most popular plan with a $0 monthly premium, $0 medical and prescription drug deductibles and a low maximum out-of-pocket of $3,425 for in-network and out-of-network costs. You get hospital, medical and prescription drug coverage, plus valuable extra benefits, all in one plan.

Blue KC makes it flexible for you to use your plan as you decide. The new Blue Benefit Bucks works like a debit card so it’s simple to use and you have the power to spend it based on your personal needs.

The Essential plan comes loaded with a $500 per year benefit allowance to use for eyewear and transportation. Plus, we’ll load your $100 per quarter over-the-counter (OTC) allowance and healthy activity rewards¹ on the same card. Your OTC allowance accumulates throughout the year, but must be spent by the end of the year.

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Advantages Include

$0 monthly premium
$0 medical and prescription drug deductibles
$0 Primary care physician copay
$0 Tier 1 and Tier 2 Prescription Drugs, up to 100-day supply
$1,000 dental benefit, each year
$0 hearing aids, and services for Level 1 devices, a $500 benefit per ear, annually
$100 over-the-counter items allowance, every 3 months
$500 Blue Benefit Bucks, flexible benefits for eyewear and transportation combined
40 hours per year for Member and Caregiver support for help to appointments or around the house
Meals support for chronic conditions
Low $3,425 annual out-of-pocket maximum in and out of network
SilverSneakers® fitness membership at no additional cost

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. You have worldwide emergency and urgent care coverage plus travel benefits with access to national BCBS network of providers.

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: Andrew, Bates, Buchanan, Cass, Clay, Clinton, Jackson, Johnson, Lafayette, Platte and Ray.

¹Rewards for healthy activities may not be used for any benefit cost sharing.

4-Star PPO plan options

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.

Every year, Medicare evaluates plans based on a 5-star rating system.

More Info

Total Premium	$0
Blue National Network	Covered
Plan Deductible	$0
Maximum Out of Pocket (MOOP)	$3,425
Inpatient Services
Inpatient Hospital - Acute	In-Network $325/day, Days 1-5 $0, Days 6-90^*	Out-of-Network 45% per stay
Skilled Nursing Facility	In-Network $20/day, Days 1-20 $188/day, Days 21-100	Out-of-Network 45%, Days 1-100
Emergency Care/Urgent Care
Emergency Care (Worldwide)	In-Network $120	Out-of-Network $120
Urgently Needed Care (Worldwide)	In-Network $50	Out-of-Network $50
Ambulance Services (Worldwide)	In-Network $300	Out-of-Network $300
Professional Services
PCP Visit	In-Network $0	Out-of-Network $25
Specialist Visit	In-Network $25	Out-of-Network $50
Telehealth	In-Network $0	Out-of-Network N/A
Diagnostic Testing Services
Diagnostic Procedures/Tests	In-Network $0	Out-of-Network 45%
Lab Services	In-Network $0	Out-of-Network 45%
X-Ray Services	In-Network $0	Out-of-Network 45%
MRI/CT at physicians office or free standing	In-Network $100	Out-of-Network 45%
MRI/CT at other facility	In-Network $250	Out-of-Network 45%
Outpatient Services
Observation	In-Network $325	Out-of-Network 45%
Outpatient Hospital & ASC (Minor surgical; other services)	In-Network 20%	Out-of-Network 45%
Surgery (Ambulatory Surgical Center)	In-Network $250	Out-of-Network 45%
Surgery (Outpatient Hospital)	In-Network $325	Out-of-Network 45%
Supplemental Services
Dental	In-Network $0 copay, 2 exams/cleaning, 1 X-ray/fluoride; 50% coinsurance for comprehensive	Out-of-Network 50% coinsurance preventive services; 50% coinsurance for comprehensive
$1,000 benefit max for preventive and comprehensive In- and Out-of-Network combined
Eyewear & Transportation	$500 Blue Benefit Bucks for transportation and eyewear combined
Hearing and Hearing Aids	$0 hearing exam; up to $500 per ear per year for hearing aids
Over-the-counter allowance	$100 per quarter

Total Premium

Blue National Network

Covered

Plan Deductible

Maximum Out of Pocket (MOOP)

$3,425

Inpatient Services

Inpatient Hospital - Acute

In-Network

$325/day, Days 1-5
$0, Days 6-90^*

Out-of-Network

45% per stay

Skilled Nursing Facility

In-Network

$20/day, Days 1-20
$188/day, Days 21-100

Out-of-Network

45%, Days 1-100

Emergency Care/Urgent Care

Emergency Care (Worldwide)

In-Network

$120

Out-of-Network

$120

Urgently Needed Care (Worldwide)

In-Network

$50

Out-of-Network

$50

Ambulance Services (Worldwide)

In-Network

$300

Out-of-Network

$300

Professional Services

PCP Visit

In-Network

Out-of-Network

$25

Specialist Visit

In-Network

$25

Out-of-Network

$50

Telehealth

In-Network

Out-of-Network

N/A

Diagnostic Testing Services

Diagnostic Procedures/Tests

In-Network

Out-of-Network

45%

Lab Services

In-Network

Out-of-Network

45%

X-Ray Services

In-Network

Out-of-Network

45%

MRI/CT at physicians office or free standing

In-Network

$100

Out-of-Network

45%

MRI/CT at other facility

In-Network

$250

Out-of-Network

45%

Outpatient Services

Observation

In-Network

$325

Out-of-Network

45%

Outpatient Hospital & ASC (Minor surgical; other services)

In-Network

20%

Out-of-Network

45%

Surgery (Ambulatory Surgical Center)

In-Network

$250

Out-of-Network

45%

Surgery (Outpatient Hospital)

In-Network

$325

Out-of-Network

45%

Supplemental Services

Dental

In-Network

$0 copay, 2 exams/cleaning, 1 X-ray/fluoride; 50% coinsurance for comprehensive

Out-of-Network

50% coinsurance preventive services; 50% coinsurance for comprehensive

$1,000 benefit max for preventive and comprehensive In- and Out-of-Network combined

Eyewear & Transportation

$500 Blue Benefit Bucks for transportation and eyewear combined

Hearing and Hearing Aids

$0 hearing exam; up to $500 per ear per year for hearing aids

Over-the-counter allowance

$100 per quarter

Annual Deductible	$0
Preferred Generics (Tier 1)	30-day Supply $0 copay	100-day Supply $0 copay
Generics (Tier 2)	30-day Supply $10 copay	100-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
$35 Insulin Program	Yes

Annual Deductible

Preferred Generics (Tier 1)

30-day Supply

$0 copay

100-day Supply

$0 copay

Generics (Tier 2)

30-day Supply

$10 copay

100-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

$35 Insulin Program

Yes

Blue Medicare Advantage

Essential (PPO)

Plan Overview

Plan Resources

Plan BenefitsAt-A-Glance

Inpatient Services

In-Network

Out-of-Network

In-Network

Out-of-Network

Emergency Care/Urgent Care

In-Network

Out-of-Network

In-Network

Out-of-Network

In-Network

Out-of-Network

Professional Services

In-Network

Out-of-Network

In-Network

Out-of-Network

In-Network

Out-of-Network

Diagnostic Testing Services

In-Network

Out-of-Network

In-Network

Out-of-Network

In-Network

Out-of-Network

In-Network

Out-of-Network

In-Network

Out-of-Network

Outpatient Services

In-Network

Out-of-Network

In-Network

Out-of-Network

In-Network

Out-of-Network

In-Network

Out-of-Network

Supplemental Services

In-Network

Out-of-Network

Prescription Drug Benefits

30-day Supply

100-day Supply

30-day Supply

100-day Supply

30-day Supply

90-day Supply

30-day Supply

90-day Supply

30-day Supply

90-day Supply

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Plan Benefits
At-A-Glance