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BlueMedicare Preferred (PFFS)

Plan costs

Premium $100.00 monthly

Benefits

Medical Coverage
Medical Deductible$1,000 Out-of-Network.
Doctor Office Visits$30 co-pay per Primary Care visit.
Specialist Office Visit$50 co-pay per visit.
Telehealth$0 co-pay for Urgently Needed Services, Primary Care Physician Services, Individual or Group Sessions for Mental Health Specialty Services, Individual or Group Sessions for Psychiatric Services.
$50 co-pay for Physician Specialist Services.
Inpatient Hospital Care$390 co-pay per day for days 1-5, $0 co-pay per day for days 6-90.
Comprehensive dental benefitsYou get comprehensive dental benefits that go far beyond the standard dental benfits covered by Original Medicare. See the Summary of Benefits to learn more.
Comprehensive hearing benefitsYou’ll receive expanded hearing benefits in addition to the standard hearing benefits covered by Original Medicare. See the Summary of Benefits to learn more.
24/7 Nurse HotlinePlan members get access to the Nurse24 nurse line, which gives you access to a registered nurse 24 hours a day, 7 days a week, 365 days a year. Nurses can provide information on home treatment of minor illnesses and injuries, how to prepare for doctor visits, understanding your prescription drugs, and much more.
SilverSneakers® fitness programThe plan offers members access to a basic fitness program at no additional cost. The benefit is administered through a plan-authorized vendor with contracted facilities. If a member is unable to access a facility, they may receive a fitness kit delivered in the mail.
In-Network Maximum Out Of Pocket$7,500.00
Medical Coverage (Out-of-Network)
Combined In and Out of Network Maximum Out of Pocket$7,500.00
Doctor Office Visits$30 co-pay per Primary Care visit Out-of-State.
40% coinsurance after deductible per visit in Arkansas Out-of-Network.
Specialist Office Visit$50 co-pay per visit Out-of-State.
40% coinsurance after deductible per visit in Arkansas Out-of-Network.
Inpatient Hospital Care
$390 co-pay per day for days 1-5; $0 co-pay per day for days 6-90 Out-of-State.
Pharmacy Coverage
Prescription Deductible$480.00
Pharmacy Deductible Drug Tier Exclusions$0 Deductible on Tier(s) 1; $480 Deductible on Tier(s) 2, 3, 4, 5
Initial Coverage Limit$4,430.00
One-Month Supply (Retail Pharmacy) with Standard Cost Sharing
Preferred Generic$5.00
Generic$20.00
Preferred Brand$47.00
Non-Preferred Drug41%
Specialty Tier25%
100-Day Supply (Mail-Order Pharmacy) with Standard Cost Sharing
Preferred Generic$12.50
Generic$50.00
Preferred Brand$117.50
Non-Preferred Drug41%
Specialty TierNot covered
Plan Documents
Summary of Benefits2022 PFFS Summary of Benefits[pdf]
Plan DocumentsPlan Documents

Preferences

Plan: H4213-017-006

Limitations, copayments, and restrictions may apply. See above or contact the plan for more details.

*Enrollee must continue to pay the Medicare Part B premium.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

  • 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048. 24 hours a day, 7 days a week.
  • The Social Security Office at 800-772-1213. TTY users should call 1-800-325-0778. Monday through Friday, 7 a.m. to 7 p.m.
  • Your State Medicaid Office.