2022 BlueMedicare Saver Choice (PPO)


BlueMedicare Saver Choice (PPO) H3554-002 is a 2022 Medicare Advantage Plan or Part-C by Arkansas Blue Medicare available to residents in Arkansas. This plan includes additional prescription drug (Part-D) coverage. The BlueMedicare Saver Choice (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,500 out-of-pocket. This can be a extremely nice safety net.

BlueMedicare Saver Choice (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.

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




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2022 Arkansas Blue Medicare Medicare Advantage Plan Costs

Name:
BlueMedicare Saver Choice (PPO)
Plan ID:
H3554-002
Provider:Arkansas Blue Medicare
Year:2022
Type: Local PPO
Monthly Premium C+D: $0
Part C Premium:$0.00
MOOP: $5,500
Part D (Drug) Premium:$0.00
Part D Supplemental Premium$0.00
Total Part D Premium:$0.00
Drug Deductible:$250.00
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: H3554-003
New Plan: 2023 H3554-003




BlueMedicare Saver Choice (PPO) Part-C Premium

Arkansas Blue Medicare charges a $0.00 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.



H3554-002 Part-D Deductible and Premium

BlueMedicare Saver Choice (PPO) has a monthly drug premium of $0.00 and a $250.00 drug deductible. This Arkansas Blue Medicare plan offers a $0.00 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 Arkansas Blue Medicare 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 $0.00 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.



Arkansas Blue Medicare Gap Coverage

In 2022 once you and your plan provider have spent $4430 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 Arkansas Blue Medicare plan does offer additional coverage through the gap.



H3554-002 Formulary or Drug Coverage

BlueMedicare Saver Choice (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. You can see complete 2022 BlueMedicare Saver Choice (PPO) H3554-002 Formulary here.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 NA $0
Tier 2 NA $15
Tier 3 NA $47
Tier 4 NA $100
Tier 5 NA 28%
Tier 6 NA $0
*Initial Coverage Phase and 30 day supply





2021 BlueMedicare Saver Choice (PPO) Summary of Benefits

*This will be updated with 2022 data when available.



Additional Benefits


No



Comprehensive Dental


Diagnostic services $0 copay
Diagnostic services 50% coinsurance (Out-of-Network)
Endodontics Not covered
Extractions $20 copay
Extractions 50% coinsurance (Out-of-Network)
Non-routine services Not covered
Periodontics Not covered
Prosthodontics, other oral/maxillofacial surgery, other services $20 copay
Prosthodontics, other oral/maxillofacial surgery, other services 50% coinsurance (Out-of-Network)
Restorative services Not covered



Deductible


$1,000 annual deductible



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) 40% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI) $0-350 copay
Diagnostic tests and procedures 40% coinsurance (Out-of-Network)
Diagnostic tests and procedures $0-350 copay
Lab services 40% coinsurance (Out-of-Network)
Lab services $0 copay
Outpatient x-rays $0-25 copay
Outpatient x-rays 40% coinsurance (Out-of-Network)



Doctor Visits


Primary $20 copay per visit
Primary $30 copay per visit (Out-of-Network)
Specialist 40% coinsurance per visit (Out-of-Network)
Specialist $50 copay per visit



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $20-50 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment 40% coinsurance (Out-of-Network)
Foot exams and treatment $40 copay
Routine foot care 40% coinsurance (Out-of-Network)
Routine foot care $40 copay



Ground Ambulance


$265 copay
$265 copay or 20% coinsurance (Out-of-Network)



Hearing


Fitting/evaluation $0 copay
Fitting/evaluation 40% coinsurance (Out-of-Network)
Hearing aids $0 copay
Hearing aids $0 copay (Out-of-Network)
Hearing exam $40 copay
Hearing exam 40% coinsurance (Out-of-Network)



Inpatient Hospital Coverage


$390 per day for days 1 through 5
$0 per day for days 6 through 90
40% per stay (Out-of-Network)



Medical Equipment/Supplies


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



Medicare Part B Drugs


Chemotherapy 20% coinsurance
Chemotherapy 40% coinsurance (Out-of-Network)
Other Part B drugs 40% coinsurance (Out-of-Network)
Other Part B drugs 20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric 40% per stay (Out-of-Network)
Inpatient hospital - psychiatric $370 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit $30 copay
Outpatient group therapy visit 40% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $30 copay
Outpatient group therapy visit with a psychiatrist 40% coinsurance (Out-of-Network)
Outpatient individual therapy visit 40% coinsurance (Out-of-Network)
Outpatient individual therapy visit $40 copay
Outpatient individual therapy visit with a psychiatrist $40 copay
Outpatient individual therapy visit with a psychiatrist 40% coinsurance (Out-of-Network)



MOOP


$11,300 In and Out-of-network
$7,500 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


$350 copay per visit
40% coinsurance per visit (Out-of-Network)



Preventive Care


40% coinsurance (Out-of-Network)
$0 copay



Preventive Dental


Cleaning 50% coinsurance (Out-of-Network)
Cleaning $0 copay
Dental x-ray(s) 50% coinsurance (Out-of-Network)
Dental x-ray(s) $0 copay
Fluoride treatment Not covered
Oral exam $0 copay
Oral exam 50% coinsurance (Out-of-Network)



Rehabilitation Services


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



Skilled Nursing Facility


$0 per day for days 1 through 20
$184 per day for days 21 through 100
40% per stay (Out-of-Network)



Transportation


Not covered



Vision


Contact lenses $0-10 copay
Contact lenses 50% coinsurance (Out-of-Network)
Eyeglass frames Not covered
Eyeglass lenses Not covered
Eyeglasses (frames and lenses) $10 copay
Eyeglasses (frames and lenses) 50% coinsurance (Out-of-Network)
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





Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST




Coverage Area for BlueMedicare Saver Choice (PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, 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 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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