Blue Medicare Advantage

Essential (PPO)

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

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 Network 45% coinsurance
Specialist Visits	In Network $25 copay	Out of Network 45% coinsurance
Podiatrist Visits	In Network $25 copay	Out of Network 45% coinsurance
Lab Services	In Network $0 copay	Out of Network 45% 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 Network 35% coinsurance
Outpatient Hospital Services	In Network 20% coinsurance	Out of Network 45% coinsurance
Outpatient Hospital Surgery	In Network $250 copay	Out of Network 45% 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

Monthly Premium

$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 Pharmacies 33% 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 Network 50% coinsurance/one per year
Diabetic Eye Exams	In Network $0 copay/one per year	Out of Network 45% 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.
Dental Preventive and Comprehensive Visits	$750 allowance per year
Acupuncture & Therapeutic Massage	In Network 12 visits per year/$20 copay per visit	Out of Network 12 visits per year/50% coinsurance
Maximum of 12 acupuncture and massage visits per year per member (in- and out-of-network combined). Get the most out of your acupuncture benefit by using an American Specialty Health (ASH) in-network provider.
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: Annual Wellness Exam or other qualified wellness visits Breast cancer screening Diabetic eye exams Flu vaccine The maximum gift card reward per member is $50 per plan year.

Blue Medicare Advantage

Essential (PPO)

Blue Medicare Advantage

Essential (PPO)

Plan Overview

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Blue Medicare advantage

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$49

Advantages Include

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Blue Medicare advantage

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$0

Advantages Include

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Blue Medicare advantage

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$0

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Blue Medicare advantage

Plus (HMO)

$34

Advantages Include

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Blue Medicare advantage

Medicare Supplement (MEDIGAP)

$130

Advantages Include

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Medical & Hospital Benefits

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