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Blue Cross Medicare Advantage Flex (PPO)
Medicare Plan Details (2022 Plan)
Monthly Premium
by Blue Cross and Blue Shield of Montana
Additional Coverage
Hearing
Overall Government Star Rating
4.0out of 5 stars
Ready to Enroll Online?
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
$222
$191
$32
$0
$0 In and Out-of-network
$0 In-network
$0 Out-of-network
$0 In-network
$0 Out-of-network
No
Yes
No
No
Medical Benefits
Doctor Services
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Tests, labs, & imaging
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
$0 copay
$0 copay
Hospital Services
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Skilled nursing facility
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Ambulance
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Therapy services
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Mental health services
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Opioid treatment services
Covered
Other services
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic | $15.00 copay |
Brand-name drugs :
|
Brand-name drugs :
|
| Generic | $20.00 copay | ||
| Preferred Brand | $47.00 copay | ||
| Non-Preferred Drug | 50% | ||
| Specialty Tier | 25% |
Part B Drugs
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Extra Benefits
Hearing
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Not covered
Not covered
Not covered
Not covered
Preventive Dental
Not covered
Not covered
Not covered
Not covered
Comprehensive dental
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Vision
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Other benefits
Limited coverage
Not covered
Not covered
Not covered
Not covered
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)
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TTY 711
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