BlueMedicare Classic Plus (HMO)
Plan costs
Premium $0.00 monthly
Benefits
| Medical Coverage | |
|---|---|
| Medical Deductible | $0.00 |
| Doctor Office Visits | $0 copay |
| Specialist Office Visit | $35 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 | $350 copay per day for days 1-5. $0 copay per day for days 6-90. |
| 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. For help with activities of daily living (ADLs) (e.g., ambulating, bathing, and dressing) and instrumental activities of daily living (IADLs) (e.g., errands, grocery shopping, and help with medication adherence). 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 | $50 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) | |
|---|---|
| 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 | |
|---|---|
| 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 | $5,030.00 |
| 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 |
| 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 | |
|---|---|
| Summary of Benefits | 2024 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.