Skip to Content (Press Enter)
Info

BlueMedicare Preferred (PFFS)

Plan costs

Premium $90.00 monthly

Benefits

Medical Coverage
Medical Deductible$1,000 (out-of-network in Arkansas)
Doctor Office Visits$20 copay
Specialist Office Visit$50 copay
Telehealth$0 copay for urgently needed services, primary care provider services, specialist services, and outpatient mental health (mental health specialty and psychiatry - individual and group sessions).
Inpatient Hospital Care$390 copay per day for days 1-5.
$0 copay per day for days 6-90.
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.
$699/$999 copay per hearing aid (2 per year).
Please see plan documents for more details.
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$7,500.00

 

Medical Coverage (Out-of-Network)
Combined In- and Out-of-Network Maximum Out-of-Pocket$7,500.00
Doctor Office Visits$20 copay out-of-network out-of-state.
40% coinsurance after deductible out-of-network in Arkansas.
Specialist Office Visit$50 copay out-of-network out-of-state.
40% coinsurance after deductible out-of-network in Arkansas.
Inpatient Hospital Care
Out-of-network out-of-state:
$390 copay per day for days 1-5
$0 copay per day for days 6-90

Out-of-network in Arkansas:
40% coinsurance after deductible
Pharmacy Coverage
Prescription Deductible$545 on Tier 2, Tier 3, Tier 4, and Tier 5
Pharmacy Deductible Drug Tier ExclusionsTier 1 and Tier 6
Initial Coverage Limit$5,030.00
One-Month Supply (Retail Pharmacy) with Standard Cost Sharing
Preferred Generic$15 copay
Generic$20 copay
Preferred Brand$47 copay
Non-Preferred Drug32% coinsurance
Specialty Tier25% coinsurance
Select Care Drugs$0 copay
Insulin Products$35 copay for a one-month supply
100-Day Supply (Mail-Order Pharmacy) with Standard Cost Sharing
Preferred Generic$37.50 copay
Generic$50 copay
Preferred Brand$117.50 copay
Non-Preferred Drug32% coinsurance
Specialty TierNot covered
Select Care Drugs$0 copay
Insulin Products$70 copay for a two-month supply or $87.50 for a three-month supply (excluding Tier 5)
Plan Documents
Summary of Benefits2024 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.