BlueMedicare Premier Choice (PPO)

Plan costs

Premium $49.00 monthly

Benefits

Medical coverage
Medical Deductible$0.00
Doctor Office Visits$0 copay
Specialist Office Visit$35
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
$375 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
$3,000 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
$1,500 allowance per hearing aid (one per year)
Please see plan documents for more details.
Comprehensive vision benefits
$0 copay for 1 routine eye exam per year.
$250 per year for routine eyewear (contacts, eyeglasses, and upgrades.
Please see plan documents for more details.
Walmart Wellness Benefits Card (Over-the-Counter Items)$50 per quarter, no rollover
Meal Benefit
$0 copay for 14 meals (two meals per day for seven days) following discharge from the hospital.
24/7 Nurse Hotline
Access to the Nurse24 nurse advice line 24 hours a day, seven 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$5,700

 

Medical coverage (Out-of-Network)
Combined In- and Out-of-Network Maximum Out-of-Pocket$9,550.00
Doctor Office Visits$20 copay
Specialist Office Visits40% coinsurance
Inpatient Hospital Care40% coinsurance

 

Pharmacy coverage
Prescription deductible$0.00
Out-of-Pocket$2,000
One-Month Supply (Retail Pharmacy) with Standard Cost Sharing
Preferred Generic$1 copay
Generic $10 copay
Preferred Brand$47 copay
Non-Preferred Drug50% coinsurance
Specialty Tier33% coinsurance
Insulin Products$35 copay for a one-month supply
100-Day Supply (Mail-Order Pharmacy) with Standard Cost Sharing
Preferred Generic$0 copay
Generic$0 copay
Preferred Brand$131 copay
Non-Preferred Drug50% coinsurance
Specialty TierNot covered
Insulin Products$70 copay for a two-month supply or $105 for a three-months supply (excluding Tier 5)

 

Plan Documents
Summary of BenefitsBlueMedicare Premier Choice (PPO) 2025 Summary of Benefits
Plan DocumentsBlueMedicare Premier Choice (PPO) Plan Documents

 

Preferences

Plan: H3554-007

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, 7:00 a.m. to 7:00 p.m.
  • Your State Medicaid Office.
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