2021 BlueMedicare Choice (Regional PPO) R3332-001 By Florida Blue.

Summary of Benefits for
2021 BlueMedicare Choice (Regional PPO)


BlueMedicare Choice (Regional PPO) R3332-001 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Florida Blue available to residents in Florida. This plan includes additional Medicare prescription drug (Part-D) coverage. The BlueMedicare Choice (Regional PPO) has a monthly premium of $47.90 and has an in-network Maximum Out-of-Pocket limit of $6,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,500 out of pocket. This can be a extremely nice safety net.

BlueMedicare Choice (Regional PPO) is a Regional 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.

Florida Blue works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for BlueMedicare Choice (Regional PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Florida Blue and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Florida Blue 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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2021 Florida Blue Medicare Advantage Plan Costs

Name:
BlueMedicare Choice (Regional PPO)
Plan ID:
R3332-001
Provider:Florida Blue
Year:2021
Type: Regional PPO
Monthly Premium C+D: $47.90
Part C Premium: $0
MOOP: $6,500
Part D (Drug) Premium: $47.90
Part D Supplemental Premium $0
Total Part D Premium: $47.90
Drug Deductible: $250.0
Tiers with No Deductible:1
Gap Coverage:Yes
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan: R3332-001




BlueMedicare Choice (Regional PPO) Part-C Premium

Florida Blue plan charges a $0 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.



R3332-001 Part-D Deductible and Premium

BlueMedicare Choice (Regional PPO) has a monthly drug premium of $47.90 and a $250.0 drug deductible. This Florida Blue plan offers a $47.90 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 this Premium covers any enhanced plan benefits offered by Florida Blue 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 $47.90. 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.



Florida Blue Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Florida Blue plan does offer additional coverage through the gap.



Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The BlueMedicare Choice (Regional PPO) medicare insurance offers a $17.10 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $24.80 for 75% low income subsidy $32.50 for 50% and $40.20 for 25%.



Full LIS Premium: $17.10
75% LIS Premium: $24.80
50% LIS Premium: $32.50
25% LIS Premium: $40.20


R3332-001 Formulary or Drug Coverage

BlueMedicare Choice (Regional PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 $0 $10
Tier 2 $10 $20
Tier 3 $40 $47
Tier 4 $93 $100
Tier 5 28% 28%
Tier 6 $0 $0
*Initial Coverage Phase and 30 day supply







2021 BlueMedicare Choice (Regional PPO) Summary of Benefits




Additional Benefits


No



Comprehensive Dental


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



Deductible


$950 annual deductible



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) $40-150 copay
Diagnostic radiology services (e.g., MRI) 50% coinsurance (Out-of-Network)
Diagnostic tests and procedures 50% coinsurance (Out-of-Network)
Diagnostic tests and procedures $0-50 copay
Lab services 50% coinsurance (Out-of-Network)
Lab services $0-40 copay
Outpatient x-rays $50-150 copay
Outpatient x-rays 50% coinsurance (Out-of-Network)



Doctor Visits


Primary 50% coinsurance per visit (Out-of-Network)
Primary $10 copay per visit
Specialist $50 copay per visit
Specialist 50% coinsurance per visit (Out-of-Network)



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $50 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment $40 copay
Foot exams and treatment 50% coinsurance (Out-of-Network)
Routine foot care Not covered



Ground Ambulance


$225 copay
$250 copay (Out-of-Network)



Hearing


Fitting/evaluation $0 copay
Fitting/evaluation 50% coinsurance (Out-of-Network)
Hearing aids 50% coinsurance (Out-of-Network)
Hearing aids $0 copay
Hearing exam 50% coinsurance (Out-of-Network)
Hearing exam $50 copay



Inpatient Hospital Coverage


$495 per day for days 1 through 27
$0 per day for days 28 through 90 (Out-of-Network)
$345 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond



Medical Equipment/Supplies


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



Medicare Part B Drugs


Chemotherapy 50% coinsurance (Out-of-Network)
Chemotherapy 20% coinsurance
Other Part B drugs 50% coinsurance (Out-of-Network)
Other Part B drugs $5 copay or 20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric $495 per day for days 1 through 27
$0 per day for days 28 through 90 (Out-of-Network)
Inpatient hospital - psychiatric $318 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit $40-150 copay (Out-of-Network)
Outpatient group therapy visit $40 copay
Outpatient group therapy visit with a psychiatrist $40 copay
Outpatient group therapy visit with a psychiatrist $40-150 copay (Out-of-Network)
Outpatient individual therapy visit $40 copay
Outpatient individual therapy visit $40-150 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $40 copay
Outpatient individual therapy visit with a psychiatrist $40-150 copay (Out-of-Network)



MOOP


$10,000 In and Out-of-network
$6,500 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


50% coinsurance per visit (Out-of-Network)
$150 copay or 20% coinsurance per visit



Preventive Care


$0 copay
50% coinsurance (Out-of-Network)



Preventive Dental


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



Rehabilitation Services


Occupational therapy visit 50% coinsurance (Out-of-Network)
Occupational therapy visit $40 copay
Physical therapy and speech and language therapy visit 50% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit $40 copay



Skilled Nursing Facility


$250 per day for days 1 through 58
$0 per day for days 59 through 100 (Out-of-Network)
$0 per day for days 1 through 20
$160 per day for days 21 through 100



Transportation


Not covered



Vision


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



Wellness Programs (e.g. fitness nursing hotline)


Covered




Reviews for BlueMedicare Choice (Regional PPO) R3332



2019 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


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
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with Health Plan

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


Member Complaints and Changes in BlueMedicare Choice (Regional PPO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals


Health Plan Customer Service Rating for BlueMedicare Choice (Regional PPO)

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


BlueMedicare Choice (Regional PPO) Drug Plan Customer Service Ratings

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


Ratings For Member Complaints and Changes in the Drug Plans Performance

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


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
Statin with Diabetes



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Sun 9am-6pm EST




Coverage Area for BlueMedicare Choice (Regional PPO)

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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, 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 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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