Plan Overview
With Blue Medciare Advantage Spira Care experience more personalized, convenient, and affordable health care—exclusively for Blue KC members.
Only Blue KC Spira Care members have access to Spira Care Centers with integrated primary care and coverage in one place, including:
- Primary care, routine preventive care, sick care
- Chronic condition management
- Behavioral health consultations
- Lab services
- X-rays (at select locations)
You will also have access to Care Guides, many with nursing and benefit backgrounds, to support you on your health journey. A Care Guide can help you navigate the health care system and make the best choices for you.
Spira Care doctors will provide your primary care. For services other than primary care, you can see doctors in the Spira Care network. For needs outside the Spira Care Centers, the costs are outlined in the Evidence of Coverage.
Advantages Include
- $0 monthly premium
- $0 medical and prescription drug deductibles
- $0 Primary care physician copay
- $0 Tier 1 and Tier 2 Prescription Drugs, up to 100-day supply
- $1,000 dental benefit, each year
- $0 hearing aids, and services for Level 1 devices, a $500 benefit per ear, annually
- $100 over-the-counter items allowance, every 3 months
- $300 Eyewear allowance
- 20 one-way trips to any health related location
- 40 hours per year for Member and Caregiver support for help to appointments or around the house
- Meals support for chronic conditions
- The support of Mid-America Regional Council (MARC) of services
- Low $3,000 annual out-of-pocket maximum in and out of network
- SilverSneakers® fitness membership at no additional cost
You'll be required to get most of your care from in-network providers. You'll also be asked to choose a Spira Care physician who will provide your basic healthcare services. You are still protected when you travel with worldwide emergency and urgent care coverage.
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.
Plan Resources
- Annual Notice of Change
- Evidence of Coverage
- Extra Help - Low Income Subsidy Information
- Summary of Benefits
- Comprehensive Prescription Drug Formulary Search – Blue Medicare Advantage
- Comprehensive Prescription Drug Formulary - Blue Medicare Advantage
- Drug Pricing Tool - Blue Medicare Advantage Spira Care
- Blue Medicare Advantage Spira Care Provider Search
- Other Plan Information
Plan Benefits
At-A-Glance
You must continue to pay Part B premium
Total Premium |
$0 |
---|---|
Blue National Network |
N/A |
Plan Deductible |
$0 |
Maximum Out of Pocket (MOOP) |
$3,000 |
Inpatient Services |
|
Inpatient Hospital - Acute |
In-Network$300/day, Days 1-5 |
Skilled Nursing Facility |
In-Network$20/day, Days 1-20 |
Emergency Care/Urgent Care |
|
Emergency Care (Worldwide) |
In-Network$120 |
Urgently Needed Care (Worldwide) |
In-Network$50 |
Ambulance Services (Worldwide) |
In-Network$300 |
Professional Services |
|
PCP Visit |
In-Network$0 |
Specialist Visit |
In-Network$30 |
Telehealth |
In-Network$0 |
Diagnostic Testing Services |
|
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$200 |
MRI/CT at other facility |
In-Network$300 |
Outpatient Services |
|
Observation |
In-Network$300 |
Outpatient Hospital & ASC (Minor surgical; other services) |
In-Network20% |
Surgery (Ambulatory Surgical Center) |
In-Network$300 |
Surgery (Outpatient Hospital) |
In-Network$300 |
Supplemental Services |
|
Dental |
In-Network100% coverage for preventive; 50% coverage for comprehensive $1,000 benefit maximum |
Eyewear |
$300 per year |
Transportation |
20 one-way trips |
Hearing and Hearing Aids |
$0 hearing exam; up to $500 per ear per year for hearing aids |
Over-the-counter allowance |
$100 per quarter |
*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$5 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 Supply33% |
90-day SupplyN/A |
Gap Coverage |
Tier 1 and Tier 2 |
|
$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
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