Blue Medicare Essential Plus (HMO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by Blue Cross and Blue Shield of North Carolina
Additional Coverage
Hearing Vision Dental
Overall Government Star Rating
 3.5
out of 5 stars

State: North Carolina

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

 

$0
$0
$0
$0
$4,200 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

$0 copay
$50 per visit

Tests, labs, & imaging

20%
20%
20%
20%
$90 per visit (always covered)
$65 per visit (always covered)

Hospital Services

$310 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 91 and beyond
$310 per visit

Skilled nursing facility

$0 per day for days 1 through 20
$178 per day for days 21 through 60
$0 per day for days 61 through 100

Preventive services

$0 copay

Ambulance

$275

Therapy services

$40
$40

Mental health services

$40
$40
$40
$40

Opioid treatment services

Covered

Other services

20% per item
20% per item
$0 copay

Prescription Drug Benefits

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

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


Generic drugs :
$3.60 copay or 5% (whichever costs more)

Brand-name drugs :
$8.95 copay or 5% (whichever costs more)

Generic$20.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug50%
Specialty Tier25%
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

20%
20%

Extra Benefits

Hearing

$50
Not covered
$699-999

Preventive Dental

$0 copay
$0 copay
$0 copay
$0 copay

Comprehensive dental

Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered

Vision

$25
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay

Other benefits

Limited coverage
Limited coverage
Not covered
Not covered
Not covered
Limited coverage
Not covered
 3.5
 4
 3
 4
 5
 4
 4
 5
 5
 3
 4

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