Plan Overview

With this PPO product, you get hospital and medical coverage, plus extra benefits, all in one plan. Blue Medicare Advantage Flex 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 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

  • $0 monthly premium
  • Low $4,000 annual out-of-pocket maximum for covered Medicare Part A and B medical costs
  • $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
  • Acupuncture benefits
  • Non-emergency medical transportation

Plan Resources

Plan Benefits
At-A-Glance

You must continue to pay Part B premium

Total Premium

$0
Visitor Travel

Not Applicable
Plan Deductible

$0
Maximum Out of Pocket (MOOP)

$4,000
Inpatient Services
Inpatient Hospital - Acute
In-Network

$285, Days 1-6; $0, Days 7-90*
Out-of-Network

$285, Days 1-6; $0, Days 7-90*
Skilled Nursing Facility
In-Network

$0, Days 1-20; $184, Days 21-100
Out-of-Network

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

$285
Out-of-Network

$285
Professional Services
PCP Visit
In-Network

$5
Out-of-Network

$5
Specialist Visit
In-Network

$20
Out-of-Network

$20
Podiatry & Routine Foot Care 6/year
In-Network

$20
Out-of-Network

$20
Diagnostic Testing Services
Other Diagnostic Procedures/Tests
In-Network

$0
Out-of-Network

$0
Lab Services
In-Network

$0
Out-of-Network

$0
X-Ray Services
In-Network

$0
Out-of-Network

$0
MRI/CT at physicians office or free standing
In-Network

$185
Out-of-Network

20%
MRI/CT at other facility
In-Network

$285
Out-of-Network

20%
Outpatient Services
Outpatient Hospital (Non-Surgical)
In-Network

20%
Out-of-Network

20%
Observation
In-Network

$285
Out-of-Network

$285
Surgery (ASC or Outpatient Hospital)
In-Network

$285
Out-of-Network

$285
Supplemental Services
Dental Services (DentaQuest) 1

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

$1,000 Benefit Maximum Combined
Vision Eyewear Benefits (EyeMed) 2

$300 Every Year
Hearing Aid (TruHearing)

$699-$999

* After 90 days, our plan covers an unlimited number of additional days for an inpatient hospital stay at $0 copay.

1 Member is responsible for charges over the Dental Benefit Maximum.

2 Member is responsible for charges over the Eyewear Benefit Maximum.

This information is not a complete description of benefits.

Sheri Blue KC Medicare Expert

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