Plan Overview

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 (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.

Blue Medicare Advantage Spira Care includes an option to buy additional eyewear and comprehensive dental services for $25 per month.

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.


Advantages Include

  • $0 monthly premiums
  • No yearly deductibles
  • Medicare Part D prescription drug coverage
  • Preventive dental services
  • Annual routine eye exam
  • Routine hearing exams and hearing aid coverage
  • Quarterly $75 over-the-counter items allowance
  • SilverSneakers® fitness membership at no additional cost
  • 24-hour Nurseline
  • Non-emergency medical transportation

Plan Resources

Plan Benefits
At-A-Glance

You must continue to pay Part B premium

Total Premium

$0

Optional supplemental benefit for Dental and Vision:
Additional $25 per month.
Visitor Travel

Not Covered
Plan Deductible

$0
Maximum Out of Pocket (MOOP)

$4,800
Inpatient Services
Inpatient Hospital - Acute
In-Network

$300, Days 1-5; $0, Days 6-90*
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

$50
Ambulance Services (Worldwide *NEW* 2021)
In-Network

$300
Professional Services
PCP Visit
In-Network

$0
Specialist Visit
In-Network

$30
Podiatry & Routine Foot Care 6/year
In-Network

$30
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

$200
MRI/CT at other facility
In-Network

$300
Outpatient Services
Outpatient Hospital (Non-Surgical)
In-Network

20%
Surgery (ASC or Outpatient Hospital)
In-Network

$300
Supplemental Services
Dental Services (DentaQuest) 1

$0 Copay, 2 Exams/Cleaning, 1 X-ray/Fluoride

Optional Supplemental benefit:

20%-50% Coinsurance for Comprehensive
Our plan pays up to $2,000 every year for Comprehensive Dental Services.

$25/Additional Monthly premium buy-up for Dental and Vision.
Vision Eyewear Benefits (EyeMed) 2
Optional Supplemental benefit:

Our plan pays up to $250 every year for eyewear.

$25/Additional Monthly premium buy-up for Dental and Vision.
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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