2023 BlueMedicare Preferred (PFFS)

BlueMedicare Preferred (PFFS) H4213-017 is a 2023 Medicare Advantage Plan or Part-C by Arkansas Blue Medicare available to residents in Arkansas. This plan includes additional prescription drug (Part-D) coverage. Arkansas Blue Medicare BlueMedicare Preferred (PFFS) has a monthly premium of $59.00 and has an in-network maximum out-of-pocket limit of $- (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $- out-of-pocket. This can be an extremely nice safety net.

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 Preferred (PFFS) 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 2023 Medicare Advantage Plan 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 if you sign up for Medicare Advantage in Arkansas.




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2023 Arkansas Blue Medicare Medicare Advantage Plan Overview

Name:BlueMedicare Preferred (PFFS)
Plan ID:H4213 017 1
Provider:Arkansas Blue Medicare
Year:2023
Type:PFFS
Combined Premium (C+D):$59.00/mo
Part C Premium:$20.50/mo
MOOP:$-/yr
Part D (Drug) Premium:$38.50/mo
Part D Supplemental Premium$0/mo
Total Part D Premium:$38.50/mo
Drug Deductible:$505.00/yr
Tiers with No Deductible:1
Gap Coverage:No
Benchmark:Not below the regional benchmark
Type of Medicare Health:Basic Alternative
Drug Benefit Type:Basic
Similar Plan: H4213-016




What type of plan is BlueMedicare Preferred (PFFS)

BlueMedicare Preferred (PFFS) is a PFFS. A Private Fee-For-Service (PFFS) plan is a Medicare Advantage (MA) health plan offered by a contract with the Centers for Medicare & Medicaid Services (CMS) to provide you with benefits. Arkansas Blue Medicare (instead of Medicare) will decide on how much it will cover and how much you will pay for the services you get. You may go to any Medicare approved doctor or hospital or any other health care provider that accepts both Medicare and your plans payment. A PFFS plan has no provider network, and you dont need a referral or a primary care physician for any health care or services. PFFS plans are the most flexible but a doctor will make a visit-by-visit decisions on whether to accept your provider.



How much does BlueMedicare Preferred (PFFS) cost?


Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Arkansas Blue Medicare charges a $59.00 consolidated premium. The Part C premium is $20.50 this charge 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

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. BlueMedicare Preferred (PFFS) has a monthly drug premium of $38.50 and a $505.00 drug deductible. This Arkansas Blue Medicare plan offers a $38.50 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 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 $38.50. The Part D Total Premium is the addition of 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 2023 once you and your plan provider have spent $4660 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 not offer additional coverage through the gap.


Extra Help Premium Assistance

The Low Income Subsidy (LIS) Extra Helps people with Medicare pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The 2022 income limit is $1,719 ($2,309 for couples) per month. Depending on your income level you may be eligible for a full 75%, 50%, 25% premium assistance. The BlueMedicare Preferred (PFFS) medicare insurance offers a $6.60 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $14.60 for 75% low-income subsidy $22.50 for 50% and $30.50 for 25%.


Full Assistance Premium:$6.60
75% Assistance Premium:$14.60
50% Assistance Premium:$22.50
25% Assistance Premium:$30.50


Formulary and Drug Coverage

BlueMedicare Preferred (PFFS) 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 NA $15
Tier 2 NA $20
Tier 3 NA $47
Tier 4 NA 32%
Tier 5 NA 25%
Tier 6 NA $0

The complete BlueMedicare Preferred (PFFS) Formulary.
*Initial Coverage Phase and 30 day supply





2023 Summary of Benefits


The benefit information provided is a summary of what BlueMedicare Preferred (PFFS) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Arkansas Blue Medicare helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

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



Contact lenses


VisionNot covered



Eyeglass frames


VisionNot covered



Eyeglass lenses


VisionNot covered



Eyeglasses (frames and lenses)


VisionNot covered



Other


VisionNot covered



Routine eye exam


VisionNot covered



Upgrades


VisionNot covered




TransportationNot covered
In-Network Skilled Nursing Facility$0 per day for days 1 through 20
$196 per day for days 21 through 100
Out-of-Network Skilled Nursing Facility40% per stay
$0 per day for days 1 through 20
$196 per day for days 21 through 100



Occupational therapy visit


In-Network Rehabilitation services$40 copay
Out-of-Network Rehabilitation services$35-40 copay or 40% coinsurance



Physical therapy and speech and language therapy visit


Out-of-Network Rehabilitation services$35-40 copay or 40% coinsurance
In-Network Rehabilitation services$40 copay



Cleaning


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental0-50% coinsurance



Dental x-ray(s)


Out-of-Network Preventive dental0-50% coinsurance
In-Network Preventive dental$0 copay



Fluoride treatment


Preventive dentalNot covered



Oral exam


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental0-50% coinsurance




In-Network Preventive care$0 copay
Out-of-Network Preventive care$0 copay or 40% coinsurance
In-Network Outpatient hospital coverage$340 copay per visit
Out-of-Network Outpatient hospital coverage$340 copay or 40% coinsurance per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo



Inpatient hospital - psychiatric


In-Network Mental health services$320 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network Mental health services40% per stay
$320 per day for days 1 through 5
$0 per day for days 6 through 90



Outpatient group therapy visit


In-Network Mental health services$35 copay
Out-of-Network Mental health services$35-40 copay or 40% coinsurance



Outpatient group therapy visit with a psychiatrist


Out-of-Network Mental health services$35-40 copay or 40% coinsurance
In-Network Mental health services$35 copay



Outpatient individual therapy visit


In-Network Mental health services$35 copay
Out-of-Network Mental health services$35-40 copay or 40% coinsurance



Outpatient individual therapy visit with a psychiatrist


In-Network Mental health services$35 copay
Out-of-Network Mental health services$35-40 copay or 40% coinsurance



Chemotherapy


Out-of-Network Medicare Part B drugs0-40% coinsurance
In-Network Medicare Part B drugs20% coinsurance



Other Part B drugs


Out-of-Network Medicare Part B drugs0-40% coinsurance
In-Network Medicare Part B drugs20% coinsurance



Diabetes supplies


Out-of-Network Medical equipment/supplies20% coinsurance per item
In-Network Medical equipment/supplies$0 copay per item



Durable medical equipment (e.g., wheelchairs, oxygen)


In-Network Medical equipment/supplies20% coinsurance per item
Out-of-Network Medical equipment/supplies20% coinsurance per item



Prosthetics (e.g., braces, artificial limbs)


Out-of-Network Medical equipment/supplies20% coinsurance per item
In-Network Medical equipment/supplies20% coinsurance per item




Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$7,500 In and Out-of-network
In-Network Inpatient hospital coverage$390 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network Inpatient hospital coverage40% per stay
$390 per day for days 1 through 5
$0 per day for days 6 through 90



Fitting/evaluation


In-Network Hearing$0 copay
Out-of-Network Hearing$0-999 copay



Hearing aids


In-Network Hearing$699-999 copay
Out-of-Network Hearing$0-999 copay



Hearing exam


Out-of-Network Hearing$50 copay or 40% coinsurance
In-Network Hearing$50 copay




Health plan deductible$1,000 Out-of-network
In-Network Ground ambulance$265 copay
Out-of-Network Ground ambulance$265 copay or 20% coinsurance



Foot exams and treatment


Out-of-Network Foot care (podiatry services)$50 copay or 40% coinsurance
In-Network Foot care (podiatry services)$50 copay



Routine foot care


Foot care (podiatry services)Not covered



Emergency


Emergency care/Urgent care$95 copay per visit (always covered)



Urgent care


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



Primary


In-Network Doctor visits$20 copay per visit
Out-of-Network Doctor visits$20 copay or 40% coinsurance per visit



Specialist


In-Network Doctor visits$50 copay per visit
Out-of-Network Doctor visits$50 copay or 40% coinsurance per visit



Diagnostic radiology services (e.g., MRI)


In-Network Diagnostic procedures/lab services/imaging$0-340 copay
Out-of-Network Diagnostic procedures/lab services/imaging$0-340 copay or 40% coinsurance



Diagnostic tests and procedures


In-Network Diagnostic procedures/lab services/imaging0-20% coinsurance
Out-of-Network Diagnostic procedures/lab services/imaging0-40% coinsurance



Lab services


In-Network Diagnostic procedures/lab services/imaging$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging$0 copay or 40% coinsurance



Outpatient x-rays


In-Network Diagnostic procedures/lab services/imaging20% coinsurance
Out-of-Network Diagnostic procedures/lab services/imaging0-40% coinsurance



Diagnostic services


Comprehensive dentalNot covered



Endodontics


Comprehensive dentalNot covered



Extractions


In-Network Comprehensive dental$20 copay
Out-of-Network Comprehensive dental0-50% coinsurance



Non-routine services


Comprehensive dentalNot covered



Periodontics


Out-of-Network Comprehensive dental0-50% coinsurance
In-Network Comprehensive dental50% coinsurance



Prosthodontics, other oral/maxillofacial surgery, other services


In-Network Comprehensive dental$20 copay or 50% coinsurance
Out-of-Network Comprehensive dental0-50% coinsurance



Restorative services


In-Network Comprehensive dental50% coinsurance
Out-of-Network Comprehensive dental0-50% coinsurance




In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No




BlueMedicare Preferred (PFFS) Reviews


Is BlueMedicare Preferred (PFFS) a good plan? BlueMedicare Preferred (PFFS) received a 3.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare BlueMedicare Preferred Reviews among several different plans.

2022 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
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with H4213-017 Health Plan

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


Member Complaints and Changes in Plans Performance

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


Health Plan Customer Service Rating for Arkansas Blue Medicare

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


Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


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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Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for BlueMedicare Preferred (PFFS) requires you to live in that plan’s service area. The service area is listed below:



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How much does BlueMedicare Preferred (PFFS) cost?

Arkansas Blue Medicare charges a $59.00 consolidated monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage of Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is BlueMedicare Preferred (PFFS) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. BlueMedicare Preferred (PFFS) by Arkansas Blue Medicare MOOP is $-. Once you spend $- you will pay nothing for Part A or Part B covered services.

What type of plan is BlueMedicare Preferred (PFFS)?

BlueMedicare Preferred (PFFS) is a PFFS. A Private Fee-For-Service (PFFS) is a plan offered by a contract with the (CMS) to provide you with benefits. PFFS plans are the most flexible but your doctor will make a visit-by-visit decisions on whether to accept your provider.

Is BlueMedicare Preferred (PFFS) a good plan?

BlueMedicare Preferred (PFFS) received a 3.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, 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 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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*Licensed Agent Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

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