Plan Overview

Simply Blue Advantage has a $0 monthly premium, $0 medical and prescription drug deductibles and a combined in-network and out-of-network maximum out-of-pocket limit of $7,250.

Simple Blue Advantage also offers a $75 per month Part B giveback meaning you receive up to $75 reduction of your monthly Part B premium. This premium reduction applies only to amounts you pay towards your Medicare Part B premium.

Enroll Online


Advantages Include

  • $0 monthly premium
  • $75 per month Part B giveback
  • $0 medical and prescription drug deductibles
  • $0 Primary care physician copay
  • $0 Tier 1 and Tier 2 Prescription Drugs, up to 100-day supply
  • Annual out-of-pocket maximum of $7,250 in and out of network
  • SilverSneakers® fitness membership at no additional cost

You won't need to choose a Primary Care Physician (PCP) or get a referral to see a specialist. You have the freedom to go out-of-network with the same cost share to either in or out-of-network partners. You have worldwide emergency and urgent care coverage plus access to national BCBS network of providers.

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: Andrew, Bates, Buchanan, Cass, Clay, Clinton, Jackson, Johnson, Lafayette, Platte and Ray.

Plan Resources

Plan Benefits
At-A-Glance

Total Premium

$0
Blue National Network

Covered
Plan Deductible

$0
Maximum Out of Pocket (MOOP)

$7,250
Inpatient Services
Inpatient Hospital - Acute
In-Network

$500/day, Days 1-4
$0, Days 5-90*
Out-of-Network

$500/day, Days 1-4
$0, Days 5-90
Skilled Nursing Facility
In-Network

$0, Days 1-20
$188/day, Days 21-100
Out-of-Network

$0, Days 1-20
$188/day, 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)
In-Network

$300
Out-of-Network

$300
Professional Services
PCP Visit
In-Network

$0
Out-of-Network

$0
Specialist Visit
In-Network

$30
Out-of-Network

$30
Telehealth
In-Network

$0
Out-of-Network

N/A
Diagnostic Testing Services
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

$150
Out-of-Network

$150
MRI/CT at other facility
In-Network

$300
Out-of-Network

$300
Outpatient Services
Observation
In-Network

$500
Out-of-Network

$500
Outpatient Hospital & ASC (Minor surgical; other services)
In-Network

20%
Out-of-Network

20%
Surgery (Ambulatory Surgical Center)
In-Network

$300
Out-of-Network

$300
Surgery (Outpatient Hospital)
In-Network

$500
Out-of-Network

$500
Supplemental Services
Dental

Not covered
Eyewear

Not covered
Transportation

Not covered
Hearing and Hearing Aids

Not covered
Over-the-counter allowance

Not covered

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

Prescription Drug Benefits

Annual Deductible

$0
Preferred Generics (Tier 1)
30-day Supply

$0 copay
100-day Supply

$0 copay
Generics (Tier 2)
30-day Supply

$10 copay
100-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
$35 Insulin Program

Yes

We offer a 100-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

Ready to Enroll?

The right Medicare Advantage plan is right around the corner. And we’ll make it easy for you to sign up.

Enroll