BlueMedicare Preferred (PFFS) H4213-017-1 Plan Details
BlueMedicare Preferred (PFFS) H4213-017-1 Plan Details
Navigating your Medicare Advantage options for 2025 can be overwhelming, but we're here to help. With BlueMedicare Preferred (PFFS) 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.
BlueMedicare Preferred Overview
Plan ID H4213-017-1 Overview | |
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Health Plan ID: | H4213-017-1 |
Medicare Advantage Plan Type: | PFFS |
Plan Year: | 2024 |
Monthly Premium: | $50.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Basic, $545.00 deductible |
Part D Gap Coverage: | No |
Supplemental Benefits: | Hearing |
Availability: | See List |
Insured By: | Arkansas Blue Medicare |
Why Choose BlueMedicare Preferred?
BlueMedicare Preferred is a Medicare Advantage Prescription Drug (MAPD) Private Fee-for-Service (PFFS) plan that offers flexibility in choosing healthcare providers. With a monthly premium of $50.00, this plan provides comprehensive coverage, including all the benefits of Medicare Part A and Part B, along with additional services like prescription drug coverage. The annual Part D deductible is $545.00. As a PFFS plan, you have the freedom to see any Medicare-approved provider who agrees to the plan’s payment terms, giving you more control over your healthcare choices.
One of the key benefits of BlueMedicare Preferred is its financial protection through an annual maximum out-of-pocket (MOOP) limit of . Once you reach this limit, the plan covers 100% of your covered healthcare costs for the remainder of the year. This makes BlueMedicare Preferred a strong option for those seeking both flexibility in provider choice and comprehensive medical and prescription drug coverage with predictable out-of-pocket expenses.
We're Here to Help You Enroll |
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Cost-Sharing Overview
With BlueMedicare Preferred, 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 H4213-017-1.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $20 Copay |
Specialist: | $50 Copay |
Wellness & Preventive Programs: | None |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $50 Copay |
Routine Foot Care: | Not Covered |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $15 Copay |
Routine chiropractic: | Not Covered |
Emergency and Urgent Care | |
Emergency room care: | $95 Copay |
Urgent care: | $50 Copay |
Ground ambulance: | $325 Copay |
Inpatient hospital care: | $390.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient hospital care: | $340 Copay |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $203.00 per day for days 21 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $35 Copay |
Outpatient group therapy: | $35 Copay |
Inpatient psychiatric hospital care: | $385.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient group therapy: | $35 Copay |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $40 Copay |
Occupational therapy: | $40 Copay |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | $0 Copay |
Durable medical equipment: | 20% Coinsurance |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $340 Copay |
Lab services: | 20% Coinsurance |
Outpatient x-rays: | 20% Coinsurance |
Diagnostic tests and procedures: | 20% Coinsurance |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Most preventive services are covered 100% by BlueMedicare Preferred as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that Arkansas Blue Medicare 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 | |
Eyeglasses (frames and lenses) (In-Network) | Not Covered |
Routine eye exam (In-Network) | Not Covered |
Contact lenses (In-Network) | Not Covered |
Additional Benefits
None specified.
Part D Prescription Drug Costs & Benefits
BlueMedicare Preferred offers a basic benefit Medicare Part D plan (PDP), meaning it meets the minimum coverage requirements set by the Centers for Medicare & Medicaid Services. In contrast, enhanced benefit plans provide additional coverage beyond the basics.
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: | $33.60 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $33.60 |
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 Arkansas Blue Medicare 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, BlueMedicare Preferred 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) | N/A | $15.00 copay (deductible does not apply) |
2 (Generic) | N/A | $20.00 copay |
3 (Preferred Brand) | N/A | $47.00 copay |
4 (Non-Preferred Drug) | N/A | 32% |
5 (Specialty Tier) | N/A | 25% |
6 (Select Care Drugs) | N/A | $0.00 copay |
CMS 5-Star Rating Overview
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
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 |
Plan Availability
BlueMedicare Preferred (H4213-017-1) is available in the following locations (click to open):
Eligibility Requirements for BlueMedicare Preferred
To enroll in BlueMedicare Preferred, 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 BlueMedicare Preferred and benefit from its comprehensive coverage options.
When Can I Enroll in BlueMedicare Preferred?
To ensure you don’t miss your chance to enroll in BlueMedicare Preferred, be aware of these important enrollment periods:
- Initial Enrollment Period (IEP): Your IEP offers a seven-month window around your 65th birthday to sign up for Medicare.
- Annual Enrollment Period (AEP): The AEP, occurring from October 15 to December 7 each year, allows you to enroll in or make changes to your Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31, the MA OEP provides an opportunity to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing insurance coverage, may qualify you for a SEP, giving you a chance to make adjustments outside the standard periods.
Need help figuring out the right time to enroll? Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711) to get assistance from a licensed insurance agent.
How to Sign Up for BlueMedicare Preferred
Joining BlueMedicare Preferred 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 BlueMedicare Preferred.
- Direct Enrollment: You can also choose to enroll directly with BlueMedicare Preferred. 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 Arkansas Blue Medicare
Website: | http://www.arkansasbluecross.com/medicare |
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Formulary: | http://www.arkansasbluecross.com |
Pharmacy: | Arkansas Blue Medicare Pharmacy Page |
New Members: | (888)605-0322 |
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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