Blue Cross Medicare Advantage Flex (PPO) 2025 Plan Details for White County, Illinois Residents
Blue Cross Medicare Advantage Flex (PPO) 2025 Plan Details for White County, Illinois Residents
When selecting a Medicare Advantage plan in White County for 2025, it's important to compare all your options. Blue Cross Medicare Advantage Flex (PPO) is among the plans you can review side-by-side with others, ensuring you find the coverage that suits your needs. You can easily enroll online or reach out to a licensed agent for personalized guidance.
Blue Cross Medicare Advantage Flex Overview
Plan ID H8634-014-0 Overview | |
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Health Plan ID: | H8634-014-0 |
Medicare Advantage Plan Type: | Local PPO |
Plan Year: | 2024 |
Monthly Premium: | $202.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | $0 |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Enhanced, $545.00 deductible |
Part D Gap Coverage: | No |
Supplemental Benefits: | Vision, Hearing |
Availability: | White County, IL |
Insured By: | Blue Cross and Blue Shield of IL, NM |
Why Consider Blue Cross Medicare Advantage Flex?
Blue Cross Medicare Advantage Flex is a Medicare Advantage Prescription Drug (MAPD) Preferred Provider Organization (PPO) plan that combines flexibility with extensive healthcare coverage. With a monthly premium of $202.00, this plan covers the core services of Medicare Part A and Part B, along with additional benefits like prescription drug coverage. The annual Part D deductible is $545.00. As a PPO plan, you have the freedom to see any provider, but in-network services will generally cost less.
A key advantage of Blue Cross Medicare Advantage Flex is its financial protection, with an annual maximum out-of-pocket (MOOP) limit of $0. Once you hit this limit, the plan covers 100% of your in-network healthcare costs for the rest of the year. This makes Blue Cross Medicare Advantage Flex a dependable option for those who seek a balance between comprehensive coverage and provider flexibility.
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Out-of-Pocket Costs
With Blue Cross Medicare Advantage Flex, 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 H8634-014-0.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | 0% Coinsurance |
Specialist: | 0% Coinsurance Prior Authorization Required |
Wellness & Preventive Programs: | None |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | 0% Coinsurance Prior Authorization Required |
Routine Foot Care: | Not Covered |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | 0% Coinsurance Prior Authorization Required |
Routine chiropractic: | Not Covered |
Emergency and Urgent Care | |
Emergency room care: | 0% Coinsurance |
Urgent care: | 0% Coinsurance |
Ground ambulance: | 0% Coinsurance |
Inpatient hospital care: | |
Outpatient hospital care: | 0% Coinsurance Prior Authorization Required |
Skilled Nursing Facility: | |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | 0% Coinsurance |
Outpatient group therapy: | 0% Coinsurance |
Inpatient psychiatric hospital care: | |
Outpatient group therapy: | 0% Coinsurance |
Outpatient individual therapy: | 0% Coinsurance Prior Authorization Required |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | 0% Coinsurance Prior Authorization Required |
Occupational therapy: | 0% Coinsurance Prior Authorization Required |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | 0% Coinsurance Prior Authorization Required |
Durable medical equipment: | 0% Coinsurance Prior Authorization Required |
Prosthetics: | 0% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | 0% Coinsurance Prior Authorization Required |
Lab services: | 0% Coinsurance Prior Authorization Required |
Outpatient x-rays: | 0% Coinsurance Prior Authorization Required |
Diagnostic tests and procedures: | 0% Coinsurance Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 0% Coinsurance |
Other Part B drugs (Medicare-covered) | 0% Coinsurance |
Most preventive services are covered 100% by Blue Cross Medicare Advantage Flex 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% Coinsurance Limitations Apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | 0% Coinsurance |
Vision | Maximum vision benefit: | Non Specified |
Eyeglasses (frames and lenses) (In-Network) | Not Covered |
Routine eye exam (In-Network) | 0% Coinsurance |
Contact lenses (In-Network) | Not Covered |
Additional Benefits
None specified.
Part D Prescription Drug Costs & Benefits
Blue Cross Medicare Advantage Flex 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: | $6.70 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $6.70 |
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 $545.00. You must pay this amount at the pharmacy before Blue Cross and Blue Shield of IL, NM begins paying its share.
NOTE: The deductible does not apply to one or more drug tiers in this plan (see "Prescription Drug Plan Out-of-Pocket Costs" below).
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Blue Cross Medicare Advantage Flex 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 (deductible does not apply) | $15.00 copay (deductible does not apply) |
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) | 25% | 25% |
How CMS Star Ratings Guide Your Choice
The Centers for Medicare & Medicaid Services (CMS) reviews and rates Medicare Advantage (Part C) and drug plans (Part D) annually, using a 5-star system to measure aspects such as member satisfaction, preventive services, and management of chronic conditions.
Higher star ratings generally indicate better plan performance, which can be a useful factor to consider when deciding on a plan that aligns with your healthcare goals and preferences.
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 Flex
You are eligible to enroll in Blue Cross Medicare Advantage Flex if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
- You do not have End-Stage Renal Disease (ESRD), with some exceptions.
If these criteria describe your situation, you’re eligible to sign up for Blue Cross Medicare Advantage Flex and take advantage of its full range of benefits.
When Can I Enroll in Blue Cross Medicare Advantage Flex?
Understanding the right time to enroll in Blue Cross Medicare Advantage Flex 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 Enroll in Blue Cross Medicare Advantage Flex
Joining Blue Cross Medicare Advantage Flex is straightforward. Here are the steps you can take:
- Online: Use our online enrollment partner's Secure Online Enrollment Form to sign up.
- By Phone: Reach out to HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711). A licensed insurance agent will help you with the enrollment process and answer any questions you might have.
- Through Medicare.gov: Enroll directly through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the steps to join Blue Cross Medicare Advantage Flex.
- Direct Enrollment: You can also choose to enroll directly with Blue Cross Medicare Advantage Flex. The contact information can be found below in the "Contact" section.
Make sure you enroll during the appropriate period to activate your coverage as soon as possible.
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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