Blue Advantage (HMO)
Medicare Plan Details
2021 Plan
Monthly Premium
| (select county for price) |
by Blue Cross and Blue Shield of Louisiana HMO
Additional Coverage
Hearing
Vision
Dental
Overall Government Star Rating
3.5out of 5 stars
State: Louisiana
Select your county to view the price for this plan
Plan Type
Medicare Advantage (Part C) with Prescription Drug (Part D)
Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D
Plan Details
$0
$0
$0
$0
$6,700 In-network
No
Yes
Yes
Yes
Medical Benefits
Doctor Services
$0 copay
$45 copay per visit
Tests, labs, & imaging
$11 copay
$0 copay
$0-200 copay
$35 copay
$90 copay per visit (always covered)
$40 copay per visit (always covered)
Hospital Services
$100 per day for days 1 through 10
$0 per day for days 11 through 90
$0 per day for days 11 through 90
$200 copay or 20% coinsurance per visit
Skilled nursing facility
$0 per day for days 1 through 20
$165 per day for days 21 through 100
$165 per day for days 21 through 100
Preventive services
$0 copay
Ambulance
$260 copay
Therapy services
$20 copay
$20 copay
Mental health services
$40 copay
$40 copay
$40 copay
$40 copay
Opioid treatment services
Covered
Other services
20% coinsurance per item
20% coinsurance per item
$0 copay
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase1 | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic | $10.00 copay | $10.00 copay |
Brand-name drugs :
|
| Generic | $18.00 copay | $18.00 copay | |
| Preferred Brand | $47.00 copay | ||
| Non-Preferred Drug | $100.00 copay | ||
| Specialty Tier | 33% | ||
| 1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs. | |||
Part B Drugs
20% coinsurance
20% coinsurance
Extra Benefits
Hearing
$10 copay
$0 copay
$0 copay
Preventive Dental
$0 copay
$0 copay
$0 copay
$0 copay
Comprehensive dental
50% coinsurance
50% coinsurance
50% coinsurance
50% coinsurance
50% coinsurance
50% coinsurance
Not covered
Vision
$0 copay
$0 copay
Not covered
$0 copay
$0 copay
Not covered
Other benefits
Limited coverage
Limited coverage
Not covered
Not covered
Limited coverage
Not covered
Limited coverage
Health Plan Star Ratings
(government star ratings are out of 5 stars)
Prescription Drug Plan Star Ratings
(government star ratings are out of 5 stars)
When Can I Sign Up for Medicare?
Enter your birthday month and year to learn when you can sign up for different Medicare plan options.
Advertisement
Medicare Health Plans
New Plan Sign Up Help
Quote & Compare
Get advice from Licensed Insurance Agents
No obligation to enroll. Find your plan online or speak with a licensed insurance agent to get help signing up for the right plan for you! Plan availability depends on your location. Licensed agents may not be able to provide assistance for all plans shown on this site.