2018 Blue Advantage Premier (PPO) H0104-015 By Blue Advantage (PPO)

2018 Medicare Advantage Blue Advantage Premier (PPO)

Blue Advantage Premier (PPO) H0104-015 is a 2018 Medicare Advantage or Medicare Part-C plan by Blue Advantage (PPO) available to residents in Alabama. This plan includes additional Medicare prescription drug (Part-D) coverage. The Blue Advantage Premier (PPO) has a monthly premium of $159.00 and has a in-network Maximum Out-of-Pocket limit of $3,400 (MOOP). This means that if you get sick or need a high cost procedure your co-pays are capped once you pay out of pocket $3,400 this can be a very nice safety net.

Blue Advantage Premier (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.

Blue Advantage (PPO) works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for Blue Advantage Premier (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Blue Advantage (PPO) and not Original Medicare. With Medicare Advantage your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from Blue Advantage (PPO) except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



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2018 Blue Advantage (PPO) Medicare Advantage Plan Details

Name:
Blue Advantage Premier (PPO)
ID:
H0104-015
Provider:Blue Advantage (PPO)
Year:2018
Type: Local PPO
Monthly Premium C+D: $159.00
MOOP: $3,400




Plan Services






Health plan deductible


$0



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures In-Network $0 copay
Diagnostic tests and procedures Out-of-Network 50%
Lab services In-Network $0 copay
Lab services Out-of-Network 50%
Diagnostic radiology services (e.g., MRI) In-Network $25
Diagnostic radiology services (e.g., MRI) Out-of-Network 50%
Outpatient x-rays In-Network $5
Outpatient x-rays Out-of-Network 50%



Hearing


Hearing exam In-Network $10
Hearing exam Out-of-Network 50%
Fitting/evaluation Not covered
Hearing aids In-Network $699-999
Hearing aids Out-of-Network $699-999



Preventive dental


Oral exam Not covered
Cleaning Not covered
Fluoride treatment Not covered
Dental x-ray(s) Not covered



Comprehensive dental


Non-routine services Not covered
Diagnostic services Not covered
Restorative services Not covered
Endodontics Not covered
Periodontics Not covered
Extractions Not covered
Prosthodontics, other oral/maxillofacial surgery, other services Not covered



Vision


Routine eye exam In-Network $0 copay
Routine eye exam Out-of-Network 50%
Other Not covered
Contact lenses In-Network $0 copay
Contact lenses Out-of-Network 50%
Eyeglasses (frames and lenses) In-Network $0 copay
Eyeglasses (frames and lenses) Out-of-Network 50%
Eyeglass frames Not covered
Eyeglass lenses Not covered
Upgrades Not covered



Mental health services


In-Network $175 for days 1 through 5
$0 for days 6 through 90
Out-of-Network 50% per stay
Outpatient group therapy visit with a psychiatrist In-Network $30
Outpatient group therapy visit with a psychiatrist Out-of-Network 50%
Outpatient individual therapy visit with a psychiatrist In-Network $30
Outpatient individual therapy visit with a psychiatrist Out-of-Network 50%
Outpatient group therapy visit In-Network $30
Outpatient group therapy visit Out-of-Network 50%
Outpatient individual therapy visit In-Network $30
Outpatient individual therapy visit Out-of-Network 50%



Skilled Nursing Facility


In-Network $0 for days 1 through 20
$100 for days 21 through 55
$0 for days 56 through 100
Out-of-Network 50% per stay



Rehabilitation services


Occupational therapy visit In-Network $30
Occupational therapy visit Out-of-Network 50%
Physical therapy and speech and language therapy visit In-Network $30
Physical therapy and speech and language therapy visit Out-of-Network 50%



Ambulance


In-Network $150
Out-of-Network $150



Transportation


Not covered



Other health plan deductibles?


In-Network No



Foot care (podiatry services)


Foot exams and treatment In-Network $20
Foot exams and treatment Out-of-Network 50%
Routine foot care Not covered



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) In-Network 20% per item
Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-Network 50% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 50% per item
Diabetes supplies In-Network $0 copay
Diabetes supplies Out-of-Network 50% per item



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


Covered



Medicare Part B drugs


Chemotherapy In-Network 20%
Chemotherapy Out-of-Network 50%
Other Part B drugs In-Network 20%
Other Part B drugs Out-of-Network 50%



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)


$5,100 In and Out-of-network
$3,400 In-network



Optional supplemental benefits


No



Inpatient hospital coverage


In-Network $175 for days 1 through 5
$0 for days 6 through 90
$0 for days 91 and beyond
Out-of-Network 50% per stay



Outpatient hospital coverage


In-Network $150 per visit
Out-of-Network 50% per visit



Doctor visits


Primary In-Network $5 per visit
Primary Out-of-Network 50% per visit
Specialist In-Network $30 per visit
Specialist Out-of-Network 50% per visit



Preventive care


In-Network $0 copay
Out-of-Network 50%



Emergency care/Urgent care


Emergency $100 per visit (always covered)
Urgent care $5-30 per visit (always covered)






Ratings for Blue Advantage Premier (PPO) H0104

2018 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Timely Care and Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Blue Advantage Premier (PPO) Plans Performance

Total Rating
Members Leaving the Plan
Complaints about Health Plan
Beneficiary Access
Health Plan Quality Improvement


Health Plan Customer Service Rating for Blue Advantage Premier (PPO)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Rheumatoid Arthritis
Improving Bladder Control
Reducing Risk of Falling
Plan - Cause Readmissions


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Beneficiary Access
Drug Plan Quality Improvement


Blue Advantage Premier (PPO) Drug Plan Customer Service ratings

Total Rating
Appeals Auto Forward
Appeals Upheld
Call Center, TTY, Foreign Language


Part-C Premium

Blue Advantage (PPO) plan charges a $98.00 Part-C 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.



Part-D Deductible and Premium

Blue Advantage Premier (PPO) has a monthly drug premium of $61.00 and a $0.00 drug deductible. This Blue Advantage (PPO) plan offers a $61.00 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Blue Advantage (PPO) above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $61.00. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.



Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Blue Advantage Premier (PPO) medicare insurance offers a $30.40 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $38.00 for 75% low income subsidy $45.70 for 50% and $53.30 for 25%.



Part C Premium: $98.00
Part D (Drug) Premium: $61.00
Part D Supplemental Premium $0.00
Total Part D Premium: $61.00
Drug Deductible: $0.00
Tiers with No Deductible: 0
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Drug Benefit Type: Enhanced
Full LIS Premium: $30.40
75% LIS Premium: $38.00
50% LIS Premium: $45.70
25% LIS Premium: $53.30
Initial Coverage Limit:$3750
Gap Coverage: No


Gap Coverage

In 2018 once you and your plan provider have spent $3750 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 35% for brand-name drugs and 44% on generic drugs unless your plan offers additional coverage. This Blue Advantage (PPO) plan does not offer additional coverage through the gap.



Coverage Area for Blue Advantage Premier (PPO)

(Click county to compare all available Advantage plans)





Source: CMS.

Data as of September 2, 2017.

Star Rating as of September 6, 2017.

For More Information on Ratings Please See the CMS Tech Notes Here.

Notes: Data are subject to change as contracts are finalized. For 2018, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.

Includes 2018 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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