Blue Medicare Advantage Essential PPO Plan

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 a combined in-network and out-of-network maximum out-of-pocket limit of $4,000. This means that if you get sick or need a high cost procedure, your copays are capped once you pay the $4,000. This plan includes a $500 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 $4,000 annual out-of-pocket maximum for covered Medicare Part A and B medical costs
Part D prescription drug coverage
$1,000 yearly dental benefit limit
$300 annual eyewear benefit maximum
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

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.

More Info

Total Premium	$0
Visitor Travel	Covered
Plan Deductible	$500^*
Maximum Out of Pocket (MOOP)	$4,000
Inpatient Services
Inpatient Hospital - Acute	In-Network $250, Days 1-5; $0, Days 6-90^**	Out-of-Network 45% per stay
Skilled Nursing Facility	In-Network $0, Days 1-20; $184, Days 21-100	Out-of-Network 45%, Days 1-100
Emergency Care/Urgent Care
Emergency Care (Worldwide)	In-Network $90	Out-of-Network $90
Urgently Needed Care (Worldwide)	In-Network $50	Out-of-Network $50
*Ambulance Services (Worldwide NEW* 2021)**	In-Network $300	Out-of-Network $300
Professional Services
PCP Visit	In-Network $5	Out-of-Network 45%
Specialist Visit	In-Network $25	Out-of-Network 45%
Podiatry & Routine Foot Care 6/year	In-Network $25	Out-of-Network 45%
Diagnostic Testing Services
Other 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 $150	Out-of-Network 45%
MRI/CT at other facility	In-Network $250	Out-of-Network 45%
Outpatient Services
Outpatient Hospital (Non-Surgical)	In-Network 20%	Out-of-Network 45%
Observation	In-Network $250	Out-of-Network 45%
Surgery (ASC or Outpatient Hospital)	In-Network $250	Out-of-Network 45%
Supplemental Services
Dental Services (DentaQuest) ¹	In-Network $0 Copay, 2 Exams/Cleaning, 1 X-ray/Fluoride; 50% Coinsurance for Comprehensive;	Out-of-Network 45% Coinsurance, 2 Exams/Cleaning, 1 X-ray/Fluoride; 45% Coinsurance for Comprehensive;
$1,000 Benefit Maximum Combined
Vision Eyewear Benefits (EyeMed) ²	$300 Every Year
Hearing Aid (TruHearing)	$699-$999

Total Premium

Visitor Travel

Covered

Plan Deductible

$500^*

Maximum Out of Pocket (MOOP)

$4,000

Inpatient Services

Inpatient Hospital - Acute

In-Network

$250, Days 1-5; $0, Days 6-90^**

Out-of-Network

45% per stay

Skilled Nursing Facility

In-Network

$0, Days 1-20; $184, Days 21-100

Out-of-Network

45%, Days 1-100

Out-of-Network

45%

Podiatry & Routine Foot Care 6/year

In-Network

$25

Out-of-Network

45%

Diagnostic Testing Services

MRI/CT at physicians office or free standing

In-Network

$150

Out-of-Network

45%

MRI/CT at other facility

In-Network

$250

Out-of-Network

45%

45%

Supplemental Services

Dental Services (DentaQuest) ¹

In-Network

$0 Copay, 2 Exams/Cleaning, 1 X-ray/Fluoride; 50% Coinsurance for Comprehensive;

Out-of-Network

45% Coinsurance, 2 Exams/Cleaning, 1 X-ray/Fluoride; 45% Coinsurance for Comprehensive;

$1,000 Benefit Maximum Combined

Vision Eyewear Benefits (EyeMed) ²

$300 Every Year

Hearing Aid (TruHearing)

$699-$999

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 Supply 33%	90-day Supply N/A
Gap Coverage	Original Medicare Standard: 25% for all Tiers

N/A

Gap Coverage

Original Medicare Standard: 25% for all Tiers

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

Supplemental Services

In-Network

Out-of-Network

Prescription Drug Benefits

30-day Supply

90-day Supply

30-day Supply

90-day Supply

30-day Supply

90-day Supply

30-day Supply

90-day Supply

30-day Supply

90-day Supply

Ready to Enroll?

Plan Benefits
At-A-Glance