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.
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
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
Other health plan deductibles?
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)
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
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)
State: |
Alabama
County: | Autauga, Baldwin, Barbour, Bibb, Blount, Bullock, Butler, Calhoun, Chambers, Cherokee, Chilton, Choctaw, Clarke, Clay, Cleburne, Coffee, Colbert, Conecuh, Coosa, Covington, Crenshaw, Cullman, Dale, Dallas, DeKalb, Elmore, Escambia, Etowah, Fayette, Franklin, Geneva, Greene, Hale, Henry, Houston, Jackson, Jefferson, Lamar, Lauderdale, Lawrence, Lee, Limestone, Lowndes, Macon, Madison, Marengo, Marion, Marshall, Mobile, Monroe, Montgomery, Morgan, Perry, Pickens, Pike, Randolph, Russell, Shelby, St. Clair, Sumter, Talladega, Tallapoosa, Tuscaloosa, Walker, Washington, Wilcox, Winston,
|
|
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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.