Medicare BlueSalute (PPO)

Medicare Plan Details (2023 Plan)


Monthly Premium

 

by Excellus Health Plan, Inc
Additional Coverage
HearingVisionDental
Overall Government Star Rating
 4.0
out of 5 stars

Ready to Enroll Online?


Plan Type

Medicare Advantage (Part C)

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

 

$0
$0
$0
$0
$7,800 In and Out-of-network
$4,500 In-network
No
Yes
Yes
Yes

Doctor Services

In-network: $5 copay per visit
Out-of-network: 30% coinsurance per visit
In-network: $35 copay per visit
Out-of-network: 30% coinsurance per visit

Tests, labs, & imaging

In-network: $15 copay
Out-of-network: 30% coinsurance
In-network: $15 copay
Out-of-network: 30% coinsurance
In-network: $150 copay
Out-of-network: 30% coinsurance
In-network: $40 copay
Out-of-network: 30% coinsurance
$95 copay per visit (always covered)
$40 copay per visit (always covered)

Hospital Services

In-network: $325 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: 30% per stay
In-network: $300 copay per visit
Out-of-network: 30% coinsurance per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$196 per day for days 21 through 100
Out-of-network: 30% per stay

Preventive services

In-network: $0 copay
Out-of-network: 0-30% coinsurance

Ambulance

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

Therapy services

In-network: $35 copay
Out-of-network: 30% coinsurance
In-network: $35 copay
Out-of-network: 30% coinsurance

Mental health services

In-network: $0 copay
Out-of-network: 30% coinsurance
In-network: $0 copay
Out-of-network: 30% coinsurance
In-network: $0 copay
Out-of-network: 30% coinsurance
In-network: $0 copay
Out-of-network: 30% coinsurance

Opioid treatment services

Covered

Other services

In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
In-network: $5 copay per item
Out-of-network: 30% coinsurance per item

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

Part B Drugs

In-network: 20% coinsurance
Out-of-network: 30% coinsurance
In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Hearing

In-network: $35 copay
Out-of-network: 30% coinsurance
In-network: $0 copay
Out-of-network: $0 copay
In-network: $499-799 copay
Out-of-network: $499-799 copay

Preventive Dental

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

Comprehensive dental

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

Vision

In-network: $0 copay
Out-of-network: 30% coinsurance
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Not covered
Not covered
Not covered

Other benefits

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

When Can I Sign Up for Medicare?

Enter your birthday month and year to learn when you can sign up for different Medicare plan options.

 

 


Ready to Enroll Online?

Please Support Our Sponsor

Advertisement

Medicare Health Plans

Get Advice & Sign Up Help
TTY 711

Speak with a Licensed Insurance Agent

Mon-Fri: 8am-9pm ET

Medicare65quote

  • Medicare Advantage Plans
  • Medicare Prescription Drug Plans
  • Medicare Supplement Insurance Plans

No obligation to enroll. Find your plan online or speak with a licensed insurance agent to get help signing up for the right plan for you! See www.medicare65quote.com for our Third-Party Marketing Organization disclaimer.

Related Articles
Best New York Medicare Advantage Health Insurance Companies for 2023

In this article we rank New York Medicare Advantage plans based on our evaluation of government 5-star quality scores. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. An overall quality score is assigned to each plan which is based on the scores of various quality metrics.

Read more →

New New York Medicare Advantage Health Insurance Companies for 2023

The Medicare landscape in New York is constantly changing. In this article we show a summary of new and returning health insurance companies offering Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D) in New York.

Read more →