Blue Cross Blue Shield Nebraska MA Core (HMO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

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

State: Nebraska

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
$6,250 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

$10 per visit
$45 per visit

Tests, labs, & imaging

$20-395
$10-395
$150-395
$20-395
$90 per visit (always covered)
$55 per visit (always covered)

Hospital Services

$395 per day for days 1 through 4
$0 per day for days 5 through 90
$395 per visit

Skilled nursing facility

$0 per day for days 1 through 20
$172 per day for days 21 through 59
$0 per day for days 60 through 100

Preventive services

$0 copay

Ambulance

$300

Therapy services

$40
$40

Mental health services

$40
$40
$40
$40

Opioid treatment services

Covered

Other services

20% per item
20% per item
0-20% per item

Prescription Drug Benefits

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

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic$14.00 copay


Generic drugs :
25%

Brand-name drugs :
25%


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

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

Generic$18.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug45%
Specialty Tier28%

Part B Drugs

20%
20%

Extra Benefits

Hearing

$10-45
$0 copay
$0 copay

Preventive Dental

$0 copay
$0 copay
Not covered
$0 copay

Comprehensive dental

Not covered
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay

Vision

$10
$0 copay
$0 copay
$0 copay
$0 copay
Not covered

Other benefits

Limited coverage
Limited coverage
Not covered
Not covered
Not covered
Limited coverage
Not covered
 3.5
 4
 3
 4
 4
No Rating
 3.5
 5
 4
 3
 3

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