BlueMedicare Saver Choice (PPO)
Plan costs
Premium $0.00 monthly
Benefits
| Medical Coverage | |
|---|---|
| Medical Deductible | $0.00 |
| Doctor Office Visits | $0 copay |
| Specialist Office Visit | $30 copay |
| Telehealth | $0 copay for urgently needed services, primary care provider services, and outpatient mental health (mental health specialty and psychiatry - individual and group sessions). $0 copay for specialist services. |
| Inpatient Hospital Care | $375 copay per day for days 1-5 $0 copay per day for days 6-90 $0 copay per day for days 91 and beyond |
| BlueMedicare Sapphire | $500 pre-loaded Mastercard debit card to help reduce out-of-pocket expenses for covered dental, vision, and hearing services |
| Healthy Blue Rewards | As an Arkansas Blue Medicare member, you’ll be eligible to earn valuable rewards for getting exams, preventive screenings, tests and completing other health-related activities. |
| Comprehensive dental benefits | $0 copay for 1 routine hearing exam per year $699/$999 copay per hearing aid (2 per year) Please see plan documents for more details. |
| Comprehensive hearing benefits | You’ll receive expanded hearing benefits in addition to the standard hearing benefits covered by Original Medicare. See the Summary of Benefits to learn more. |
| Comprehensive vision benefits | You’ll also get expanded vision benfits in addition to the standard vision benefis covered by Original Medicare. See the Summary of Benfits to learn more. |
| Over-the-Counter Items | $40 per quarter. |
| Meal Benefit | Up to 14 nutritious meals (two meals per day for seven days) per year following discharge from the hospital. |
| 24/7 Nurse Hotline | Access to the Nurse24 nurse advice line 24 hours a day, 7 days a week, 365 days a year. Registered nurses can provide information on home treatment of minor illnesses and injuries, how to prepare for doctor visits, how to understand your prescription drugs, and much more. |
| SilverSneakers® fitness program | Access to a fitness benefit virtually and at participating SilverSneakers facilities, giving you access to instructor-led group exercise classes, exercise equipment, and options to get active outside of traditional gyms, as well as virtual options. |
| In-Network Maximum Out Of Pocket | $5,000.00 |
| Medical Coverage (Out-of-Network) | |
|---|---|
| Combined In and Out of Network Maximum Out of Pocket | $8,950.00 |
| Doctor Office Visits | $30 copay |
| Specialist Office Visit | 40% coinsurance |
| Inpatient Hospital Care | 40% coinsurance |
| Pharmacy Coverage | |
|---|---|
| Prescription Deductible | $250 on Tier 4 and Tier 5 |
| Pharmacy Deductible Drug Tier Exclusions | Tier(s) 1, 2, 3, 6 |
| Initial Coverage Limit | $4,660.00 |
| One-Month Supply (Retail Pharmacy) with Standard Cost Sharing | |
| Preferred Generic | $0 copay |
| Generic | $15 copay |
| Preferred Brand | $47 copay |
| Non-Preferred Drug | $100 copay |
| Specialty Tier | 29% coinsurance |
| Select Care Drugs | $0 copay |
| Part D Senior Savings Model | $0 copay for Select Insulins (30-day and 100-day fills). |
| 100-Day Supply (Mail-Order Pharmacy) with Standard Cost Sharing | |
| Preferred Generic | $0 copay |
| Generic | $0 copay |
| Preferred Brand | $141 copay |
| Non-Preferred Drug | $300 copay |
| Specialty Tier | Not covered |
| Select Care Drugs | $0 copay |
| Plan Documents | |
|---|---|
| Summary of Benefits | 2023 PPO Summary of Benefits[pdf] |
| Plan Documents | Plan Documents |
Preferences
Plan: H3554-002
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.