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.

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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 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
$0, Days 6-90*

Skilled Nursing Facility
In-Network

$20/day, Days 1-20
$188/day, Days 21-100

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-Network

20%

Surgery (Ambulatory Surgical Center)
In-Network

$300

Surgery (Outpatient Hospital)
In-Network

$300

Supplemental Services
Dental
In-Network

100% 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 Supply

33%

90-day Supply

N/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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