Blue Medicare Advantage Flex (no Part D) (PPO)

Medicare Plan Details

2021 Plan

Monthly Premium

(select county for price)

by Blue Medicare Advantage

Additional Coverage

Hearing Vision Dental

Overall Government Star Rating

4.0

out of 5 stars

State: Missouri

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

Monthly Premium

Health Portion of Premium

Drug Portion of Premium

Health Plan Deductible

Health Plan Max Out-of-Pocket

$4,000 In and Out-of-network
$4,000 In-network

Nationwide Coverage included

Hearing Coverage included

Yes

Vision Coverage included

Yes

Dental Coverage included

Yes

Doctor Lookup Link

http://www.MedicareBlueKC.com

Plan Link

http://www.MedicareBlueKC.com

Medical Benefits

Doctor Services

Primary doctor visit

In-network: $5 copay per visit
Out-of-network: $5 copay per visit

Specialist visit

In-network: $20 copay per visit
Out-of-network: $20 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures

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

Lab services

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

Diagnostic radiology services (like MRI)

In-network: $185-285 copay
Out-of-network: 20% coinsurance

Outpatient x-rays

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

Emergency care

$90 copay per visit (always covered)

Urgent care

$50 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage

In-network: $285 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-network: $285 per day for days 1 through 6
$0 per day for days 7 through 90

Outpatient hospital coverage

In-network: $285 copay or 20% coinsurance per visit
Out-of-network: $285 copay or 20% coinsurance per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$184 per day for days 21 through 100
Out-of-network: $0 per day for days 1 through 20
$184 per day for days 21 through 100

Preventive services

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

Ambulance

Ground ambulance

In-network: $285 copay
Out-of-network: $285 copay or 20% coinsurance

Therapy services

Occupational therapy visit

In-network: $20 copay
Out-of-network: $20 copay

Physical therapy & speech & language therapy visit

In-network: $20 copay
Out-of-network: $20 copay

Mental health services

Outpatient group therapy with a psychiatrist

In-network: $20 copay
Out-of-network: $20 copay

Outpatient individual therapy with a psychiatrist

In-network: $20 copay
Out-of-network: $20 copay

Outpatient group therapy visit

In-network: $20 copay
Out-of-network: $20 copay

Outpatient individual therapy visit

In-network: $20 copay
Out-of-network: $20 copay

Opioid treatment services

Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)

In-network: 20% coinsurance per item
Out-of-network: 0-20% coinsurance per item

Prosthetics (like braces, artificial limbs)

In-network: 20% coinsurance per item
Out-of-network: 0-20% coinsurance per item

Diabetes supplies

In-network: 0-20% coinsurance per item
Out-of-network: 0-20% coinsurance per item

Prescription Drug Benefits

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

Part B Drugs

Chemotherapy drugs

In-network: 20% coinsurance
Out-of-network: $285 copay or 20% coinsurance

Other Part B drugs

In-network: 0-20% coinsurance
Out-of-network: $285 copay or 20% coinsurance

Extra Benefits

Hearing

Hearing exam

In-network: $20 copay
Out-of-network: $20 copay

Fitting/evaluation

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

Hearing aids - All types

In-network: $699-999 copay
Out-of-network: $699-999 copay

Preventive Dental

Oral exam

In-network: $0 copay
Out-of-network: 0-50% coinsurance

Cleaning

In-network: $0 copay
Out-of-network: 0-50% coinsurance

Fluoride treatment

In-network: $0 copay
Out-of-network: 0-50% coinsurance

Dental x-rays

In-network: $0 copay
Out-of-network: 0-50% coinsurance

Comprehensive dental

Non-routine services

In-network: 50% coinsurance
Out-of-network: 0-50% coinsurance

Diagnostic services

In-network: 50% coinsurance
Out-of-network: 0-50% coinsurance

Restorative services

In-network: 50% coinsurance
Out-of-network: 0-50% coinsurance

Endodontics

In-network: 50% coinsurance
Out-of-network: 0-50% coinsurance

Periodontics

In-network: 50% coinsurance
Out-of-network: 0-50% coinsurance

Extractions

In-network: 50% coinsurance
Out-of-network: 0-50% coinsurance

Prosthodontics, other oral/maxillofacial surgery, other services

Not covered

Vision

Routine eye exam

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

Contact lenses

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

Eyeglasses (frames & lenses)

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

Eyeglass frames (only)

Not covered

Eyeglass lenses (only)

Not covered

Upgrades

Not covered

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

Not covered

Annual physical exams

Limited coverage

Telehealth

Limited coverage

Summary rating of health plan quality

Staying healthy: screenings, tests, & vaccines

Managing chronic (long term) conditions

Member experience with health plan

Member complaints & changes in the health plan's performance

Health plan customer service

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