BlueMedicare Classic Plus (HMO)
Plan costs
Premium $0.00 monthly
Benefits
Medical Coverage | |
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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)
$40 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 |
Healthy Blue Rewards | As a Health Advantage member, you’ll be eligible to earn valuable rewards for getting exams, preventive screenings, tests and completing other health-related activities. |
In-Home Support Services | $0 copay for 40 hours per year. Get in-person or virtual help with making medical appointments, transportation, chores, meal prep, companionship, etc. Plus, no prerequisite to access services. |
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. $100 per year for routine eyewear (contacts, eyeglasses, and upgrades). Please see plan documents for more details. |
Over-the-Counter Items | $25 per quarter |
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 | $6,200.00 |
Medical Coverage (Out-of-Network) | |
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Out-of-network coverage | Out-of-network services are not covered, except for emergency and urgently needed care. You must use network providers for plan services, except in emergency situations. |
Pharmacy Coverage | |
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Prescription Deductible | $250 on Tier 3, Tier 4, and Tier 5 |
Pharmacy Deductible Drug Tier Exclusions | Tier 1, Tier 2, and Tier 6 |
Initial Coverage Limit | $4,660.00 |
One-Month Supply (Retail Pharmacy) with Standard Cost Sharing | |
Preferred Generic | $3 copay |
Generic | $10 copay |
Preferred Brand | $47 copay |
Non-Preferred Drug | 36% coinsurance |
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 | $6 copay |
Generic | $20 copay |
Preferred Brand | $94 copay |
Non-Preferred Drug45% | 36% coinsurance |
Specialty Tier | Not covered |
Select Care Drugs | $0 copay |
Plan Documents | |
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Summary of Benefits | 2023 HMO Summary of Benefits [pdf] |
Plan Documents | Plan Documents |
Preferences
Plan: H9699-006
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.