Plan Overview

With this HMO product, you get freedom of choice (no referrals) and a focus on helping you navigate your health care choices so that you get the right care, at the right time. This plan includes hospital, medical and prescription drug coverage, plus extra benefits, all in one plan. Blue Medicare Advantage Plus has a monthly premium of $45, no deductibles and an in-network maximum out-of-pocket limit of $5,200. This means that if you get sick or need a high cost procedure, your copays are capped once you pay the $5,200. You'll be required to get most of your care from an in-network provider. You'll also be asked to choose a primary care physician who will provide your basic healthcare services.

To join, you must be entitled to Medicare Part A, be enrolled in Medicare Part B, and live in one of these counties in Kansas: Johnson and Wyandotte, and these counties in Missouri: Cass, Clay, Clinton, Jackson, Lafayette, Platte and Ray.


Advantages Include

  • $45 monthly premiums
  • No yearly deductibles
  • Medicare Part D prescription drug coverage
  • $1,000 yearly dental benefit limit
  • $250 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

Plan Benefits
At-A-Glance

You must continue to pay Part B premium

Total Premium

$45

Visitor Travel

Not Covered

Plan Deductible

$0

Maximum Out of Pocket (MOOP)

$5,200

Inpatient Services
Inpatient Hospital - Acute
In-Network

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

Skilled Nursing Facility
In-Network

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

Emergency Care/Urgent Care
Emergency Care (Worldwide)
In-Network

$90

Urgently Needed Care (Worldwide)
In-Network

$40

Ambulance Services (Worldwide *NEW* 2021)
In-Network

$285

Professional Services
PCP Visit
In-Network

$5

Specialist Visit
In-Network

$40

Podiatry & Routine Foot Care 6/year
In-Network

$45

Diagnostic Testing Services
Other Diagnostic Procedures/Tests
In-Network

$0

Lab Services
In-Network

$0

X-Ray Services
In-Network

$0

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

$185

MRI/CT at other facility
In-Network

$285

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

20%

Surgery (ASC or Outpatient Hospital)
In-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

$250 Every Year

Hearing Aid (TruHearing)

$399-$699

* 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.

Prescription Drug Benefits

Annual Deductible

$0

Preferred Generics (Tier 1)
30-day Supply

$0 copay

90-day Supply

$0 copay

Generics (Tier 2)
30-day Supply

$5 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

T1 & T2 with same copay amounts & Tiers 3, 4 & 5 at 25%

We offer a 90-day mail order and retail drug benefit with a $0 copay for all Tier 1 and Tier 2 prescription drugs.

This information is not a complete description of benefits.

Sheri Blue KC Medicare Expert

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