Blue Cross Medicare Advantage Choice MA Only (PPO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by Blue Cross Blue Shield of Minnesota
Additional Coverage
Hearing Vision Dental
Overall Government Star Rating
 4.5
out of 5 stars

State: Minnesota

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B

 

$35
$35
$0
$0
$7,500 In and Out-of-network
$4,900 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

In-network: $10 per visit
Out-of-network: 45% per visit
In-network: $30 per visit
Out-of-network: 45% per visit

Tests, labs, & imaging

In-network: 15%
Out-of-network: 45%
In-network: $0
Out-of-network: $0 copay
In-network: 15%
Out-of-network: 45%
In-network: 15%
Out-of-network: 45%
$90 per visit (always covered)
$45 per visit (always covered)

Hospital Services

In-network: $200 per stay
Out-of-network: 45% per stay
In-network: $20-200 per visit
Out-of-network: 45% per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$178 per day for days 21 through 100
Out-of-network: 45% per stay

Preventive services

In-network: $0 copay
Out-of-network: 45%

Ambulance

In-network: $200
Out-of-network: $200

Therapy services

In-network: $30
Out-of-network: 45%
In-network: $30
Out-of-network: 45%

Mental health services

In-network: $30
Out-of-network: 45%
In-network: $30
Out-of-network: 45%
In-network: $30
Out-of-network: 45%
In-network: $30
Out-of-network: 45%

Opioid treatment services

Covered

Other services

In-network: 20% per item
Out-of-network: 45% per item
In-network: 20% per item
Out-of-network: 45% per item
In-network: $0 per item
Out-of-network: 45% per item

Prescription Drug Benefits

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

Part B Drugs

In-network: 20%
Out-of-network: 45%
In-network: 20%
Out-of-network: 45%

Extra Benefits

Hearing

In-network: $30
Out-of-network: 45%
Not covered
In-network: $599-899
Out-of-network: $599-899

Preventive Dental

Covered under office visit
Covered under office visit
Not covered
Covered under office visit

Comprehensive dental

Not covered
Not covered
Not covered
Not covered
In-network: $0 copay
Out-of-network: $0 copay
Not covered
Not covered

Vision

In-network: $0 copay
Out-of-network: 45%
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Not covered

Other benefits

Limited coverage
Limited coverage
Not covered
Not covered
Not covered
Limited coverage
Not covered
 4
 4
 3
 5
 4
 5

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