Blue Cross Medicare Advantage Basic (HMO) 2025 Plan Details for Moultrie County, Illinois Residents
Blue Cross Medicare Advantage Basic (HMO) 2025 Plan Details for Moultrie County, Illinois Residents
Navigating your Medicare Advantage options in Moultrie County for 2025 can be overwhelming, but we're here to help. With Blue Cross Medicare Advantage Basic (HMO) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
Blue Cross Medicare Advantage Basic Overview
Plan ID H3822-012-0 Overview | |
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Health Plan ID: | H3822-012-0 |
Medicare Advantage Plan Type: | Local HMO |
Plan Year: | 2024 |
Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | $4,900 |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
Part D Gap Coverage: | Yes |
Supplemental Benefits: | Vision, Hearing |
Availability: | Moultrie County, IL |
Insured By: | Blue Cross and Blue Shield of IL, NM |
Why Choose Blue Cross Medicare Advantage Basic?
Blue Cross Medicare Advantage Basic is a Medicare Advantage Prescription Drug (MAPD) Health Maintenance Organization (HMO) plan that provides comprehensive healthcare coverage. With a monthly premium of $0.00, this plan includes the essential benefits of Medicare Part A and Part B, as well as additional services like prescription drug coverage. There is no annual deductible. Cost sharing begins with your first prescription. As an HMO plan, you’ll typically need to use providers within the plan’s network, except in emergencies.
One of the important aspects of Blue Cross Medicare Advantage Basic is its protection against high medical expenses. The annual maximum out-of-pocket (MOOP) limit is $4,900, ensuring that once this amount is reached, the plan covers 100% of your in-network healthcare costs for the rest of the year. This makes Blue Cross Medicare Advantage Basic a reliable choice for those looking for a plan that combines medical and prescription drug coverage with predictable out-of-pocket expenses.
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Cost-Sharing Overview
With Blue Cross Medicare Advantage Basic, you'll have cost-sharing expenses, which are the out-of-pocket costs for approved healthcare services. The table below provides a summary of the typical in-network out-of-pocket costs associated with plan H3822-012-0.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $0 Copay |
Specialist: | $25 Copay Prior Authorization Required, Referral Required |
Wellness & Preventive Programs: | None |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $40 Copay Prior Authorization Required, Referral Required |
Routine Foot Care: | Not Covered |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $20 Copay Prior Authorization Required, Referral Required |
Routine chiropractic: | Not Covered |
Emergency and Urgent Care | |
Emergency room care: | $120 Copay |
Urgent care: | $40 Copay |
Ground ambulance: | $250 Copay |
Inpatient hospital care: | $275.00 per day for days 1 through 7 $0.00 per day for days 8 and beyond |
Outpatient hospital care: | $175 Copay Prior Authorization Required, Referral Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $203.00 per day for days 21 through 49 $0.00 per day for days 50 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $40 Copay |
Outpatient group therapy: | $40 Copay |
Inpatient psychiatric hospital care: | $250.00 per day for days 1 through 7 $0.00 per day for days 8 and beyond |
Outpatient group therapy: | $40 Copay |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $40 Copay Prior Authorization Required, Referral Required |
Occupational therapy: | $40 Copay Prior Authorization Required, Referral Required |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | 20% Coinsurance Prior Authorization Required |
Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $250 Copay Prior Authorization Required, Referral Required |
Lab services: | $0 Copay Prior Authorization Required, Referral Required |
Outpatient x-rays: | $0 Copay Prior Authorization Required, Referral Required |
Diagnostic tests and procedures: | $50 Copay Prior Authorization Required, Referral Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Most preventive services are covered 100% by Blue Cross Medicare Advantage Basic as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that Blue Cross and Blue Shield of IL, NM offers with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | $0 Copay Limitations Apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $0 Copay |
Vision | Maximum vision benefit: | $100.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | Not Covered |
Routine eye exam (In-Network) | $0 Copay |
Contact lenses (In-Network) | $0 Copay |
Additional Benefits
None specified.
Part D Prescription Drug Costs & Benefits
Blue Cross Medicare Advantage Basic includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
While the prescription drug plan (Part D) premium is included in the overall plan cost, some plans may have additional costs or provide assistance through the Low-Income Subsidy (LIS) program. Also known as Extra Help, LIS is a Social Security program that assists individuals with limited income and resources in reducing or eliminating Part D expenses.
The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $0.00 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $0.00 |
Part D Premium with Full LIS Assistance: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. You must pay this amount at the pharmacy before Blue Cross and Blue Shield of IL, NM begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Blue Cross Medicare Advantage Basic has out-of-pocket costs that you must pay when you pick up your prescriptions.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | $0.00 copay | $15.00 copay |
2 (Generic) | $8.00 copay | $20.00 copay |
3 (Preferred Brand) | $47.00 copay | $47.00 copay |
4 (Non-Preferred Drug) | $100.00 copay | $100.00 copay |
5 (Specialty Tier) | 33% | 33% |
CMS 5-Star Rating Overview
Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates health and drug plans using a comprehensive 5-star rating system. These ratings offer valuable insights into the quality of care, member satisfaction, and overall plan performance.
When selecting a Medicare Advantage plan, looking at the star ratings can help you gauge how well a plan might meet your healthcare needs, making it easier to choose a plan with confidence.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
Eligibility Requirements for Blue Cross Medicare Advantage Basic
To enroll in Blue Cross Medicare Advantage Basic, you must meet the following criteria:
- Be eligible for Medicare Part A and Part B.
- Reside in the plan’s service area.
- Not have End-Stage Renal Disease (ESRD), with some exceptions.
If you meet these requirements, you are eligible to enroll in Blue Cross Medicare Advantage Basic and benefit from its comprehensive coverage options.
When Should You Enroll in Blue Cross Medicare Advantage Basic?
Understanding the right time to enroll in Blue Cross Medicare Advantage Basic is crucial. Here are the key enrollment periods:
- Initial Enrollment Period (IEP): Your first opportunity to enroll in Medicare starts three months before your 65th birthday and lasts until three months after your birthday month.
- Annual Enrollment Period (AEP): Occurring annually from October 15 to December 7, the AEP allows you to enroll in, switch, or drop a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31 each year, the MA OEP gives you the chance to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing other coverage, may make you eligible for a SEP, allowing you to adjust your plan outside the usual periods.
Not sure when to enroll? Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711) to speak with a licensed insurance agent who can guide you through your options.
How to Sign Up for Blue Cross Medicare Advantage Basic
Getting started with Blue Cross Medicare Advantage Basic is simple. Here are your options:
- Online Enrollment: Easily enroll online using a secure form. Visit the MedicareEnrollment.com enrollment page and follow the steps to complete your enrollment.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711). A licensed insurance agent will guide you through the process and answer any questions.
- Through Medicare.gov: Enroll through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the instructions to join a Medicare Advantage plan.
- Directly with the Plan: You can also enroll directly with Blue Cross Medicare Advantage Basic. The plan's contact information is available below in the "Contact" section.
Be sure to enroll during the appropriate period to ensure your coverage begins without delay.
Contact Blue Cross and Blue Shield of IL, NM
Website: | http://getblueil.com/mapd |
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Formulary: | http://getblueil.com/mapd/pharmacies |
Pharmacy: | Blue Cross and Blue Shield of IL, NM Pharmacy Page |
New Members: | (877)583-8129 |
TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, you can do so on the Social Security Administration website. For more information about the Medicare Part C program, visit the official Medicare website or call 1-800-MEDICARE.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
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