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Blue Medicare Advantage Valor PPO (PPO)

South Dakota Medicare Advantage Plan (2024 Plan)

Monthly Premium
Your Cost
$0
by Wellmark Advantage Health Plan
Additional Coverage
HearingVisionDental
Overall Government Star Rating
 3.5
out of 5 stars

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Plan Overview

Plan Name
Blue Medicare Advantage Valor PPO (PPO)
Insurance Carrier
Wellmark Advantage Health Plan
Plan Type
Medicare Advantage Plan Without Prescription Drugs
Network Type
PPO

Blue Medicare Advantage Valor PPO (PPO) is a Medicare Advantage Plan Without Prescription Drugs, which is available in South Dakota and offered by the health insurance company Wellmark Advantage Health Plan. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.

Cost Summary

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$5,000
Primary doctor visit
$0 copay
Specialist visit
$40 copay per visit
ER visit
$120 copay per visit (always covered)
Ambulance
$325 copay

Blue Medicare Advantage Valor PPO (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $5,000 In and Out-of-network $5,000 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Blue Medicare Advantage Valor PPO (PPO) are defined below.

Additional Benefits and Coverage

No
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Blue Medicare Advantage Valor PPO (PPO) is a Medicare Advantage plan which does not include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Blue Medicare Advantage Valor PPO (PPO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Blue Medicare Advantage Valor PPO (PPO) includes coverage for the following additional benefits:

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
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Comparing the Quality Score of Blue Medicare Advantage Valor PPO (PPO) to Other Plans in South Dakota

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, Blue Medicare Advantage Valor PPO (PPO) received an overall government quality rating of 3.5 stars out of 5 stars.

Blue Medicare Advantage Valor PPO (PPO) performed worse than South Dakota’s State average overall quality score of 4.0 stars.

This Plan’s 5-star Gov’t Quality Score
South Dakota State Average Score
Overall Government 5 Star Quality Rating
 3.5
 4.0
Summary rating of health plan quality
 4
 4.0
Staying healthy: screenings, tests, & vaccines
No Rating (new plan)
 3.6
Managing chronic (long term) conditions
 3
 3.2
Member experience with health plan
 4
 4.1
Member complaints & changes in the health plan's performance
 5
 4.4
Health plan customer service
No Rating (new plan)
 4.7

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Blue Medicare Advantage Valor PPO (PPO) received 4 stars for its health plan quality score which is the same as the South Dakota State average health plan quality score of 4.0 stars.

Plan Benefits and Coverage Details

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$5,000 In and Out-of-network
$5,000 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link
http://www.Wellmark.com/Finder-Medicare
Plan Link
http://www.Wellmarkadvantagehealthplan.com

Medical Benefits

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist visit
In-network: $40 copay per visit
Out-of-network: $40 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0-100 copay
Out-of-network: $0-100 copay
Lab services
In-network: $5 copay
Out-of-network: $5 copay
Diagnostic radiology services (like MRI)
In-network: $0-100 copay
Out-of-network: $0-100 copay
Outpatient x-rays
In-network: $20 copay
Out-of-network: $20 copay
Emergency care
$120 copay per visit (always covered)
Urgent care
$60 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $380 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: $380 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage
In-network: $40-325 copay per visit
Out-of-network: $40-325 copay per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 per day for days 1 through 20
$203 per day for days 21 through 55
$0 per day for days 56 through 100
Out-of-network: $0 per day for days 1 through 20
$203 per day for days 21 through 55
$0 per day for days 56 through 100

Preventive services

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

Ambulance

Ground ambulance
In-network: $325 copay
Out-of-network: $325 copay

Therapy services

Occupational therapy visit
In-network: $40 copay
Out-of-network: $40 copay
Physical therapy & speech & language therapy visit
In-network: $40 copay
Out-of-network: $40 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $40 copay
Out-of-network: $40 copay
Outpatient individual therapy with a psychiatrist
In-network: $40 copay
Out-of-network: $40 copay
Outpatient group therapy visit
In-network: $40 copay
Out-of-network: $40 copay
Outpatient individual therapy visit
In-network: $40 copay
Out-of-network: $40 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 0-20% 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: 20% coinsurance per item
Diabetes supplies
In-network: $0 copay
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: 0-20% coinsurance
Out-of-network: $35 copay or 20% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: $35 copay or 20% coinsurance

Extra Benefits

Hearing

Hearing exam
In-network: $0-40 copay
Out-of-network: $0-40 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - All types
In-network: $0 copay
Out-of-network: $0 copay

Preventive Dental

Oral exam
Covered under office visit
Cleaning
Covered under office visit
Fluoride treatment
Not covered
Dental x-rays
Covered under office visit

Comprehensive dental

Non-routine services
Not covered
Diagnostic services
Not covered
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: 0-50% 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
In-network: 0-50% coinsurance
Out-of-network: 0-50% coinsurance

Vision

Routine eye exam
In-network: $0 copay
Out-of-network: 50% coinsurance
Contact lenses
In-network: $0 copay
Out-of-network: 50% coinsurance
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: 50% coinsurance
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: 50% coinsurance
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: 50% coinsurance
Upgrades
In-network: $0 copay
Out-of-network: 50% coinsurance

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