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BlueMedicare Value Choice (PPO)

Plan costs

Premium $29.00 monthly


Medical Coverage
Medical Deductible$0.00
Doctor Office Visits$0 copay
Specialist Office Visit$40 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).
$20 copay for specialist services.
Inpatient Hospital Care$345 co-pay per day for days 1-5.
$0 co-pay 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 RewardsAs 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$2,000 per year for comprehensive (and preventive) dental services.
Please see plan documents for more details.
Comprehensive hearing benefits$0 copay for 1 routine hearing exam per year.
$1,000 per 3 years for 2 hearing aids (one per ear).
Please see plan documents for more details.
Comprehensive vision benefits$0 copay for 1 routine eye exam per year.
$150 per year for routine eyewear (contacts, eyeglasses, and upgrades).
Please see plan documents for more details.
Over-the-Counter Items$40 per quarter
Meal Benefit$0 copay for 14 meals per year (2 meals per day for 7 days) following discharge from the hospital.
24/7 Nurse HotlineAccess 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 programAccess 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$6,000.00
Medical Coverage (Out-of-Network)
Combined In and Out of Network Maximum Out of Pocket$8,950.00
Doctor Office Visits$25 copay
Specialist Office Visit40% coinsurance
Inpatient Hospital Care40% coinsurance
Pharmacy Coverage
Prescription Deductible$150 on Tier 4 and Tier 5
Pharmacy Deductible Drug Tier ExclusionsTier(s) 1, 2, 3, 6
Initial Coverage Limit$4,660.00
One-Month Supply (Retail Pharmacy) with Standard Cost Sharing
Preferred Generic$1 copay
Generic$13 copay
Preferred Brand$47 copay
Non-Preferred Drug$100 copay
Specialty Tier30% 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 TierNot covered
Select Care Drugs$0 copay
Plan Documents
Summary of Benefits2023 PPO Summary of Benefits[pdf]
Plan DocumentsPlan Documents


Plan: H3554-004

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.