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.

COMPARE AND SAVE ON MEDICARE INSURANCE

2018 Blue Advantage (PPO) Medicare Advantage Plan Details

Plan Services

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Health plan deductible

$0

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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%

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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

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Preventive dental

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

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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

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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

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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%

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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

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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%

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Ambulance

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

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Transportation

Not covered

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Other health plan deductibles?

	In-Network	No

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Foot care (podiatry services)

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

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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

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

Covered

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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%

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

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

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Optional supplemental benefits

No

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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

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Outpatient hospital coverage

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

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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

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Preventive care

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

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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

Member Experience with Health Plan

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

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

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ratings For Member Complaints and Changes in the Drug Plans Performance

Blue Advantage Premier (PPO) Drug Plan Customer Service ratings

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%.

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.