2023 Secure Blue Courage (PPO)

Secure Blue Courage (PPO) H1302-004 is a 2023 Medicare Advantage Plan or Part-C by Blue Cross of Idaho available to residents in Idaho. This plan does not provide extra prescription drug (Part-D) coverage. Blue Cross of Idaho Secure Blue Courage (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,600 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $5,600 out-of-pocket. This can be an extremely nice safety net.

Blue Cross of Idaho works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Secure Blue Courage (PPO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Blue Cross of Idaho and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from Blue Cross of Idaho except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Idaho.



2023 Blue Cross of Idaho Medicare Advantage Plan Overview

Name:Secure Blue Courage (PPO)
Plan ID:H1302 004 0
Provider:Blue Cross of Idaho
Year:2023
Type:Local PPO *
Combined Premium (C+D):$0/mo
MOOP:$5,600/yr
Similar Plan: H1302-004




What type of plan is Secure Blue Courage (PPO)

Secure Blue Courage (PPO) is a Local PPO *. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network, but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

How much does Secure Blue Courage (PPO) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Blue Cross of Idaho charges a $0 premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Secure Blue Courage (PPO) by Blue Cross of Idaho MOOP is $5,600. Once you spend $5,600 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.





2023 Summary of Benefits


The benefit information provided is a summary of what Secure Blue Courage (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Blue Cross of Idaho helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)Covered



Contact lenses


In-Network Vision$0-35 copay
Out-of-Network Vision$35 copay



Eyeglass frames


VisionNot covered



Eyeglass lenses


VisionNot covered



Eyeglasses (frames and lenses)


In-Network Vision$35 copay
Out-of-Network Vision$35 copay



Other


VisionNot covered



Routine eye exam


In-Network Vision$20 copay
Out-of-Network Vision$20 copay



Upgrades


Out-of-Network Vision$35 copay
In-Network Vision$0 copay




TransportationNot covered
In-Network Skilled Nursing Facility$0 per day for days 1 through 20
$196 per day for days 21 through 100
Out-of-Network Skilled Nursing Facility$100 per day for days 1 through 12
$196 per day for days 13 through 100



Occupational therapy visit


In-Network Rehabilitation services$40 copay
Out-of-Network Rehabilitation services$45 copay



Physical therapy and speech and language therapy visit


In-Network Rehabilitation services$40 copay
Out-of-Network Rehabilitation services$45 copay



Cleaning


Preventive dentalCovered under office visit



Dental x-ray(s)


Preventive dentalCovered under office visit



Fluoride treatment


Preventive dentalCovered under office visit



Office visit


In-Network Preventive dental$25.00
Out-of-Network Preventive dental50% coinsurance



Oral exam


Preventive dentalCovered under office visit




In-Network Preventive care$0 copay
Out-of-Network Preventive care$0 copay
In-Network Outpatient hospital coverage$325 copay per visit
Out-of-Network Outpatient hospital coverage20% coinsurance per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo



Inpatient hospital - psychiatric


In-Network Mental health services$350 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network Mental health services$350 per day for days 1 through 10
$0 per day for days 11 through 90



Outpatient group therapy visit


In-Network Mental health services$0 copay
Out-of-Network Mental health services25% coinsurance



Outpatient group therapy visit with a psychiatrist


In-Network Mental health services$40 copay
Out-of-Network Mental health services25% coinsurance



Outpatient individual therapy visit


Out-of-Network Mental health services25% coinsurance
In-Network Mental health services$0 copay



Outpatient individual therapy visit with a psychiatrist


Out-of-Network Mental health services25% coinsurance
In-Network Mental health services$40 copay



Chemotherapy


In-Network Medicare Part B drugs20% coinsurance
Out-of-Network Medicare Part B drugs30% coinsurance



Other Part B drugs


Out-of-Network Medicare Part B drugs30% coinsurance
In-Network Medicare Part B drugs20% coinsurance



Diabetes supplies


In-Network Medical equipment/supplies$0 copay
Out-of-Network Medical equipment/supplies30% coinsurance per item



Durable medical equipment (e.g., wheelchairs, oxygen)


Out-of-Network Medical equipment/supplies30% coinsurance per item
In-Network Medical equipment/supplies20% coinsurance per item



Prosthetics (e.g., braces, artificial limbs)


Out-of-Network Medical equipment/supplies30% coinsurance per item
In-Network Medical equipment/supplies20% coinsurance per item




Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$7,000 In and Out-of-network
$5,600 In-network
Out-of-Network Inpatient hospital coverage$350 per day for days 1 through 10
$0 per day for days 11 through 90
In-Network Inpatient hospital coverage$350 per day for days 1 through 5
$0 per day for days 6 through 90



Fitting/evaluation


HearingNot covered



Hearing aids


Out-of-Network Hearing$699-999 copay
In-Network Hearing$699-999 copay



Hearing exam


In-Network Hearing$40 copay
Out-of-Network Hearing$45 copay




Health plan deductible$0
In-Network Ground ambulance$275 copay
Out-of-Network Ground ambulance$275 copay



Foot exams and treatment


In-Network Foot care (podiatry services)$40 copay
Out-of-Network Foot care (podiatry services)$45 copay



Routine foot care


Foot care (podiatry services)Not covered



Emergency


Emergency care/Urgent care$95 copay per visit (always covered)



Urgent care


Emergency care/Urgent care$40 copay per visit (always covered)



Primary


Out-of-Network Doctor visits$45 copay per visit
In-Network Doctor visits$0 copay



Specialist


In-Network Doctor visits$40 copay per visit
Out-of-Network Doctor visits$45 copay per visit



Diagnostic radiology services (e.g., MRI)


In-Network Diagnostic procedures/lab services/imaging$250 copay
Out-of-Network Diagnostic procedures/lab services/imaging25% coinsurance



Diagnostic tests and procedures


In-Network Diagnostic procedures/lab services/imaging$30 copay or 10% coinsurance
Out-of-Network Diagnostic procedures/lab services/imaging25% coinsurance



Lab services


Out-of-Network Diagnostic procedures/lab services/imaging25% coinsurance
In-Network Diagnostic procedures/lab services/imaging$0 copay



Outpatient x-rays


In-Network Diagnostic procedures/lab services/imaging$15 copay
Out-of-Network Diagnostic procedures/lab services/imaging25% coinsurance



Diagnostic services


Comprehensive dentalNot covered



Endodontics


In-Network Comprehensive dental50% coinsurance
Out-of-Network Comprehensive dental50% coinsurance



Extractions


Out-of-Network Comprehensive dental50% coinsurance
In-Network Comprehensive dental$25 copay



Non-routine services


In-Network Comprehensive dental$25 copay
Out-of-Network Comprehensive dental50% coinsurance



Periodontics


In-Network Comprehensive dental$25 copay
Out-of-Network Comprehensive dental50% coinsurance



Prosthodontics, other oral/maxillofacial surgery, other services


Out-of-Network Comprehensive dental50% coinsurance
In-Network Comprehensive dental50% coinsurance



Restorative services


In-Network Comprehensive dental$25 copay
Out-of-Network Comprehensive dental50% coinsurance




In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No




Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Secure Blue Courage (PPO) requires you to live in that plan’s service area. The service area is listed below:



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How much does Secure Blue Courage (PPO) cost?

Blue Cross of Idaho charges a $0 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is Secure Blue Courage (PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Secure Blue Courage (PPO) by Blue Cross of Idaho MOOP is $5,600. Once you spend $5,600 you will pay nothing for Part A or Part B covered services.

What type of plan is Secure Blue Courage (PPO)?

Secure Blue Courage (PPO) is a Local PPO *. A (PPO) is a Medicare plan that has contracts with a network of preferred providers. You do not need to select a primary care physician and you do not need referrals to see other providers in the network.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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