Most Mapd Plans Feature $0 Copay On Tier 1

Most Mapd Plans Feature $0 Copay On Tier 1
Most Mapd Plans Feature $0 Copay On Tier 1 Credit Card
Most Mapd Plans Feature $0 Copay On Tier 1 Property

Blue Cross Medicare Advantage Basic (HMO) ^SM	Blue Cross Medicare Advantage Basic Plus (HMO‑POS)^SM		Blue Cross Medicare Advantage Premier Plus (HMO‑POS)^SM		Blue Cross Medicare Advantage Choice Plus (PPO) ^SM		Blue Cross Medicare Advantage Choice Premier (PPO) ^SM
In-Network	Out-of-Network	In-Network	Out-of-Network	In-Network	Out-of-Network	In-Network	Out-of-Network
Plan Premium	$0	$0		$83		$79		$141.10
Doctors Office Visits
Primary Care Provider	$0 copay	$10 copay	$60 copay	$5 copay	$60 copay	$25 copay	50% coinsurance	$15 copay	50% coinsurance
Specialist	$30 copay	$40 copay	$75 copay	$35 copay	$75 copay	$40 copay	50% coinsurance	$50 copay	50% coinsurance
Prescription Drug Copay	Tier 1: $0 – $5 copay Full coverage of Tier 1 in gap	Tier 1: $0 – $5 copay Full coverage of Tier 1 in gap		Tier 1: $0 – $5 copay Full coverage of Tier 1 in gap		Tier 1: $3 – $8 copay Full coverage of Tier 1 in gap		Tier 1: $0 – $5 copay Full coverage of Tier 1 in gap
Prescription Drug Deductible	$0 Deductible	$0 Deductible		$0 Deductible		$435 Deductible Tiers 4 & 5		$0 Deductible
Extra Health & Wellness Benefits
Optional Supplemental Benefits Premium	not available	$27.10^*		not available		$32.30^*		not available
Dental
Preventive	$0 copay per visit; 2 exams, 2 cleanings, 1 X-ray	^* $0 copay per visit; 2 exams, 2 cleanings, 1 X-ray		$0 copay per visit; 2 exams, 2 cleanings, 1 X-ray	not covered	^*$0 copay per visit; 2 exams, 2 cleanings, 1 X-ray		$0 copay per visit; 2 exams, 2 cleanings, 1 X-ray
Comprehensive	$500 Annual Maximum	^* 50% Basic Restorative; 70% Major Restorative $1,000 Annual Maximum		$500 Annual Maximum		^* 50% Basic Restorative; 70% Major Restorative $1,000 Annual Maximum		not covered
Vision
Eye Exam	$0 copay	$0 copay		$0 copay $25 copay lenses	not covered	$0 copay	$40 allowance	$0 copay	$40 allowance
Eyewear	$150 two-year maximum	^* $150 per year allowance		$100 two-year maximum		^* $150 per year allowance	^* $150 per year allowance
Hearing
Hearing Exam	not covered	^* $5 copay		^* $5 copay	not covered	^* $5 copay		not covered
Hearing Aids		^*$1,000 three-year maximum		^*$1,000 three-year maximum		^*$1,000 three-year maximum
Over-the-Counter (OTC) Purchase Allowance	$75 / quarterly	not available		not available		not available		not available
Free SilverSneakers^® Fitness Program	✓	✓		✓		✓		✓
24/7 NurseLine	✓	✓		✓		✓		✓
Transportation	$0 copay / up to 12 one-way trips every year to plan-approved locations	$0 copay / up to 12 one-way trips every year to plan-approved locations	not covered	$0 copay / up to 12 one-way trips every year to plan-approved locations	not covered	not covered		not covered

^* These benefits only available with Optional Supplemental Benefit package and additional premium.

Get more from your Medicare with the Benefit of Blue^SM. Enroll today.

With multiple options from which to choose, there’s a Blue Cross Medicare Advantage plan for you. Need help deciding? Talk to your licensed, authorized agent or call one of our product specialists.

Plan Premium: $0: $0: $62: Doctors Office Visits: Primary Care Provider: $0 copay: $10 copay: 50% coinsurance: $15 copay: 50% coinsurance: Specialist: $20 copay: $50 copay: $45 copay: Prescription Drug Copay: Tier 1: $0 – $5 copay Full coverage of Tier 1 in gap: Tier 1: $0 – $5 copay Full coverage of Tier 1 in gap: Tier 1: $0 – $5 copay Full coverage of Tier 1 in gap. Confidential and Proprietary Information 1 2017 DSNP and MAPD Plans in South Texas. 2017 BENEFIT DESIGN.RX Coverage - Generics: $0 Copay Tier 1 (preferred generics); All other drugs $0-$7.40 Copay.No deductible.$3,400 MOOP. Additional Gap Coverage Tier 1&6 $0 Tier 1&6 $0 Tier 1&6 $0. Tier 1: $0 – $5 copay Full coverage of Tier 1 in gap: Prescription Drug Deductible: $0 Deductible: $0 Deductible: $0 Deductible: $435 Deductible Tiers 4 & 5: $0 Deductible: Extra Health & Wellness Benefits: Optional Supplemental Benefits Premium: not available: $27.10. not available: $32.30. not available: Dental: Preventive: $0 copay per visit; 2 exams, 2 cleanings, 1 X-ray. $0 copay per visit; 2 exams, 2 cleanings, 1 X-ray: $0 copay per visit; 2 exams, 2 cleanings, 1. 1 $0 copay for days 1 through 20 1 $176 copay per day for days 21 through 100 These amounts may change for 2021. No prior hospitalization is required. Prior authorization may be required. Physical Therapy Physical therapy and speech therapy. 20% of the cost. Prior authorization may be required. Cardiac and pulmonary rehabilitation. 20% of the cost.

Web

Our secure online form takes you through enrollment step-by-step. It’s easy.

One-on-One Help

Get personalized enrollment help from a product specialist or your licensed, authorized agent.

Call our product specialist:
1-888-890-8931 • TTY 711

Learn more at a free seminar

Attend a free seminar to learn about all your Medicare options.

See the Plan Comparison Chart for details about each plan.