Blue Cross Medicare Advantage Value (HMO)

Illinois Medicare Advantage Plan (2024 Plan)


Monthly Premium
by Blue Cross and Blue Shield of Illinois
Additional Coverage
HearingVisionDental
Overall Government Star Rating
 2.5
out of 5 stars

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Plan Name
Blue Cross Medicare Advantage Value (HMO)
Insurance Carrier
Blue Cross and Blue Shield of Illinois
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO

Blue Cross Medicare Advantage Value (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Illinois and offered by the health insurance company Blue Cross and Blue Shield of Illinois. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$2,900
Primary doctor visit
$0 copay
Specialist visit
$18 copay per visit
ER visit
$135 copay per visit (always covered)
Ambulance
$250 copay

Blue Cross Medicare Advantage Value (HMO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $2,900 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Blue Cross Medicare Advantage Value (HMO) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Blue Cross Medicare Advantage Value (HMO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Blue Cross Medicare Advantage Value (HMO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Blue Cross Medicare Advantage Value (HMO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, Blue Cross Medicare Advantage Value (HMO) received an overall government quality rating of 2.5 stars out of 5 stars.

Blue Cross Medicare Advantage Value (HMO) performed worse than Illinois’s State average overall quality score of 3.9 stars.

This Plan’s 5-star Gov’t Quality Score
Illinois State Average Score
Overall Government 5 Star Quality Rating
 2.5
 3.9
Summary rating of health plan quality
 3
 3.8
Staying healthy: screenings, tests, & vaccines
 5
 3.7
Managing chronic (long term) conditions
 3
 3.3
Member experience with health plan
 2
 3.8
Member complaints & changes in the health plan's performance
 3
 3.9
Health plan customer service
 4
 4.2
Summary rating of drug plan quality
 3
 3.8
Drug plan customer service
 4
 4.1
Member complaints & changes in the drug plan's performance
 3
 4.1
Member experience with the drug plan
 2
 3.8
Drug safety & accuracy of drug pricing
 3
 3.4

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Blue Cross Medicare Advantage Value (HMO) received 3 stars for its health plan quality score which is worse than the Illinois State average health plan quality score of 3.8 stars.

Blue Cross Medicare Advantage Value (HMO) received 3 stars for its drug plan quality score which is worse than the Illinois State average drug plan quality score of 3.8 stars.


Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$2,900 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$18 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
$0-50 copay
Lab services
$0 copay
Diagnostic radiology services (like MRI)
$0-175 copay
Outpatient x-rays
$0 copay
Emergency care
$135 copay per visit (always covered)
Urgent care
$30 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$250 per day for days 1 through 7
$0 per day for days 8 through 90
Outpatient hospital coverage
$250 copay per visit

Skilled nursing facility

Skilled nursing facility
$0 per day for days 1 through 20
$203 per day for days 21 through 39
$0 per day for days 40 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$250 copay

Therapy services

Occupational therapy visit
$35 copay
Physical therapy & speech & language therapy visit
$35 copay

Mental health services

Outpatient group therapy with a psychiatrist
$30 copay
Outpatient individual therapy with a psychiatrist
$30 copay
Outpatient group therapy visit
$30 copay
Outpatient individual therapy visit
$30 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
20% coinsurance per item
Prosthetics (like braces, artificial limbs)
20% coinsurance per item
Diabetes supplies
0-35% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$15.00 copay$15.00 copay


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic$20.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier33%
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
0-20% coinsurance

Hearing

Hearing exam
$35 copay
Fitting/evaluation
$0 copay
Hearing aids - All types
$699-999 copay

Preventive Dental

Oral exam
$0 copay
Cleaning
$0 copay
Fluoride treatment
Not covered
Dental x-rays
$0 copay

Comprehensive dental

Non-routine services
0% coinsurance
Diagnostic services
Not covered
Restorative services
0% coinsurance
Endodontics
20% coinsurance
Periodontics
20% coinsurance
Extractions
20% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services
20% coinsurance

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
Not covered

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