BlueMedicare Independence (HMO)
Plan costs
Premium $20.90 monthly
Benefits
Medical coverage | |
---|---|
Medical Deductible | $0.00 |
Doctor Office Visits | $0 copay |
Specialist Office Visit | $25 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 | $300 copay per day for days 1-5. $0 copay per day for days 6-90. |
BlueMedicare Sapphire | $500 pre-loaded Mastercard debit card to help reduce out-of-pocket expenses for covered dental, vision, and hearing services. |
Healthy Blue Rewards | As 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. |
In-Home Support Services | $0 copay for 80 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). Services are provided in two-hour and four-hour increments depending on the scheduled service. |
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. $1,000 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) | $155 per quarter, no rollover |
Walmart Wellness Benefits Card (Food and Produce) | $25 per month, no rollover The benefit mentioned here is part of a special supplemental program
for the chronically ill. Not all members qualify for it. |
Meal Benefit | $0 copay for 14 meals (two meals per day for seven days) following discharge from the hospital. |
Transportation | $0 copay per trip for 60 one-way trips per year to plan-approved healthrelated locations. |
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 | $4,000 |
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 | $590 on Tier 2, Tier 3, Tier 4, and Tier 5 |
Out-of-Pocket | $2,000 |
One-Month Supply (Retail Pharmacy) with Standard Cost Sharing | |
Preferred Generic | $4 copay |
Generic | $18 copay |
Preferred Brand | 20% coinsurance |
Non-Preferred Drug | 50% coinsurance |
Specialty Tier | 25% coinsurance |
Insulin Products | $35 copay for a one-month supply |
100-Day Supply (Mail-Order Pharmacy) with Standard Cost Sharing | |
Preferred Generic | $12 copay |
Generic | $54 copay |
Preferred Brand | 20% coinsurance |
Non-Preferred Drug | 50% coinsurance |
Specialty Tier | Not covered |
Insulin Products | $70 copay for a two-month supply or $105 for a three-months supply (excluding Tier 5) |
Plan Documents | |
---|---|
Summary of Benefits | BlueMedicare Independence (HMO) 2025 Summary of Benefits |
Plan Documents | BlueMedicare Independence (HMO) Plan Documents |
Preferences
Plan: H6158-003
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.