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 monthly premium of $15 and an in-network maximum out-of-pocket limit of $6,700. This means that if you get sick or need a high cost procedure, your copays are capped once you pay the $6,700. This plan 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: Cass, Clay, Clinton, Jackson, Lafayette, Platte and Ray.


Advantages Include

  • $15 monthly premium
  • Access to a nationwide network of doctors and hospitals
  • Medicare Part D prescription drug coverage
  • Large network of doctors and hospitals in Kansas City’s nine-county service area
  • Routine hearing exams and hearing aid coverage
  • SilverSneakers® fitness membership at no additional cost
  • 24-hour Nurseline
  • Member Rewards program
  • $0 deductibles for Medicare Part A and Part B

Wondering which Medicare plan is right for you? We can help.

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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:

  1. You are a U.S. citizen or legal resident
  2. You have resided in the United States for a minimum of 5 years
  3. You have worked at least 10 years in Medicare-covered employment
  4. 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)

Advantages Include

  • $49 premium
  • Access to a nationwide network of doctors and hospitals
  • Medicare Part D prescription drug coverage
  • Large network of doctors and hospitals in Kansas City’s nine-county service area
  • Routine hearing exams and hearing aid coverage
  • SilverSneakers® fitness membership at no additional cost
  • 24-hour Nurseline
  • Member Rewards program
  • Preventive dental visits
  • Worldwide emergency room and urgent care coverage
  • $0 deductibles for Medicare Part A and Part B
Enroll Now

Call to learn more about this plan.

Call 1-855-208-8246 (TTY: 711) 8 a.m. to 8 p.m., Monday - Friday

Based on your selections, we recommend...

Blue Medicare advantage

Essential (PPO)

Advantages Include

  • $15 premium
  • Access to a nationwide network of doctors and hospitals
  • Medicare Part D prescription drug coverage
  • Large network of doctors and hospitals in Kansas City’s nine-county service area
  • Routine hearing exams and hearing aid coverage
  • SilverSneakers® fitness membership at no additional cost
  • 24-hour Nurseline
  • Member Rewards program
  • Worldwide emergency room and urgent care coverage
  • $0 deductibles for Medicare Part A and Part B
Enroll Now

Call to learn more about this plan.

Call 1-855-208-8246 (TTY: 711) 8 a.m. to 8 p.m., Monday - Friday

Based on your selections, we recommend...

Blue Medicare advantage

Complete (HMO)

Advantages Include

  • $0 premium plan
  • Large network of doctors and hospitals in Kansas City’s nine-county service area
  • All Original Medicare coverage (Part A and Part B) plus prescription drug coverage (Part D)
  • Routine hearing exams and hearing aid coverage
  • SilverSneakers® fitness membership at no additional cost
  • 24-hour Nurseline
  • Member Rewards program
  • Worldwide emergency room and urgent care coverage
  • $0 deductibles for Medicare Part A and Part B
Enroll Now

Call to learn more about this plan.

Call 1-855-208-8246 (TTY: 711) 8 a.m. to 8 p.m., Monday - Friday

Based on your selections, we recommend...

Blue Medicare advantage

Plus (HMO)

Advantages Include

  • $29 premium
  • Large network of doctors and hospitals in Kansas City’s nine-county service area
  • All Original Medicare coverage (Part A and Part B) plus prescription drug coverage (Part D)
  • Preventive dental visits
  • Routine eye exams, eyewear and contacts
  • Routine hearing exams and hearing aid coverage
  • SilverSneakers® fitness membership at no additional cost
  • 24-hour Nurseline
  • Member Rewards program
  • Worldwide emergency room and urgent care coverage
  • $0 deductibles for Medicare Part A and Part B
Enroll Now

Call to learn more about this plan.

Call 1-855-208-8246 (TTY: 711) 8 a.m. to 8 p.m., Monday - Friday

Based on your selections, we recommend...

Blue Medicare advantage

Medicare Supplement (MEDIGAP)

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
Enroll Now

Call to learn more about this plan.

Call 1-855-208-8246 (TTY: 711) 8 a.m. to 8 p.m., Monday - Friday

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Medical & Hospital Benefits

You must continue to pay Part B premium

Monthly Premium

$15 per month
Maximum Out-of-Pocket Limit*
In Network

$6,700 per year
Combined

$10,000 per year
Primary Care Provider Visits
In Network

$7 copay
Out of Network

35% coinsurance
Specialist Visits
In Network

$50 copay
Out of Network

35% coinsurance
Podiatrist Visits
In Network

$50 copay
Out of Network

35% coinsurance
Lab Services
In Network

$0 copay
Out of Network

35% coinsurance
Inpatient Hospital Care
In Network

$360 copay per day for days 1-5, $0 copay per day for days 6-90, $0 copay for additional days.
Out of Network

35% coinsurance
Outpatient Hospital Services (Hospital Surgery)
In Network

$350 copay
Out of Network

35% coinsurance
Urgent Care**
In Network

$50 copay
Out of Network

$50 copay
Emergency Care**
In Network

$90 copay
Out of Network

$90 copay
Ambulance (Ground & Air)
In Network

$290 copay
Out of Network

$290 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.

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 mail order prescription drug benefit with a $0 copay for all Generics (Tier 1 and Tier 2) at retail or mail order.

Valuable Extra Benefits

SilverSneakers

Included at no additional cost
24-Hour Nurseline

Included at no additional cost
Vision

Routine Eye Exams
In Network

$10 copay/one per year
Out of Network

50% coinsurance/one per year

Eyeglass Lenses
In Network

Not covered
Out of Network

Not covered

Eyeglass Frames or Contact Lenses
In Network

Not covered
Out of Network

Not covered
In-Network routine vision exams offered through EyeMed Insight Network providers only.
Hearing

Routine Hearing Exams
In Network

$45 copay/one per year
Out of Network

$45 copay/one per year

Hearing Aids
In Network

$699–$999 copay per aid
Out of Network

$699–999 copay per aid
In-Network routine hearing exam and Hearing Aids offered through TruHearing providers only.
TruHearing Advanced and Premium hearing aids only.
Dental

Preventive Visits

Not covered

Plan Resources

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