Blue Cross Medicare Advantage Protect (PPO) H4801-019-0 Plan Details
Blue Cross Medicare Advantage Protect (PPO) H4801-019-0 Plan Details
Navigating your Medicare Advantage options for 2025 can be overwhelming, but we're here to help. With Blue Cross Medicare Advantage Protect (PPO) 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 Protect Overview
Plan ID H4801-019-0 Overview | |
---|---|
Health Plan ID: | H4801-019-0 |
Medicare Advantage Plan Type: | Local PPO |
Plan Year: | 2024 |
Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $750.00 |
Annual Out-of-Pocket Maximum: | $6,350 |
Part B Give Back: | $50.00/mo |
Part D Drug Plan Benefit: | Not Included |
Part D Gap Coverage: | No |
Supplemental Benefits: | Vision, Hearing |
Availability: | See List |
Insured By: | Blue Cross and Blue Shield of OK, TX |
Why Consider Blue Cross Medicare Advantage Protect?
Blue Cross Medicare Advantage Protect is a Medicare Advantage Preferred Provider Organization (PPO) plan that offers comprehensive and flexible healthcare coverage. With a monthly premium of $0.00, this plan includes all the benefits of Medicare Part A and Part B, ensuring you have access to essential medical care. As a PPO plan, Blue Cross Medicare Advantage Protect gives you the freedom to choose any Medicare-approved provider, with the added benefit of lower costs when you stay within the plan’s network.
Note that Blue Cross Medicare Advantage Protect does not include Part D prescription drug coverage. For prescription drug needs, explore Medicare drug plans available separately. A key benefit of Blue Cross Medicare Advantage Protect is its financial protection through an annual maximum out-of-pocket (MOOP) limit of $6,350. Once you reach this limit, the plan covers 100% of your in-network healthcare costs for the remainder of the year. This makes Blue Cross Medicare Advantage Protect an ideal choice for those who seek both flexibility and comprehensive healthcare coverage.
We're Here to Help You Enroll |
---|
Out-of-Pocket Costs
With Blue Cross Medicare Advantage Protect, 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 H4801-019-0.
Service | Enrollee Cost |
---|---|
Doctor's Office Visit (In-Network) | |
Primary: | $0 Copay |
Specialist: | $50 Copay Prior Authorization Required |
Wellness & Preventive Programs: | None |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $40 Copay Prior Authorization Required |
Routine Foot Care: | Not Covered |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $20 Copay Prior Authorization Required |
Routine chiropractic: | Not Covered |
Emergency and Urgent Care | |
Emergency room care: | $120 Copay |
Urgent care: | $40 Copay |
Ground ambulance: | $275 Copay |
Inpatient hospital care: | $370.00 per day for days 1 through 6 $0.00 per day for days 7 and beyond |
Outpatient hospital care: | $300 Copay Prior Authorization 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: | $290.00 per day for days 1 through 6 $0.00 per day for days 7 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 |
Occupational therapy: | $40 Copay Prior Authorization 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: | $300 Copay Prior Authorization Required |
Lab services: | $50 Copay Prior Authorization Required |
Outpatient x-rays: | $100 Copay Prior Authorization Required |
Diagnostic tests and procedures: | $100 Copay Prior Authorization 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 Protect as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that Blue Cross and Blue Shield of OK, TX offers with this plan:
Supplemental Healthcare Service | Member Cost |
---|---|
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
This plan does not include a Medicare Part D plan for prescriptions.
Understanding CMS Star Ratings
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 |
---|---|
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
Blue Cross Medicare Advantage Protect (H4801-019-0) is available in the following locations (click to open):
Who Can Enroll in Blue Cross Medicare Advantage Protect?
You are eligible to enroll in Blue Cross Medicare Advantage Protect 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 Protect and take advantage of its full range of benefits.
When Should You Enroll in Blue Cross Medicare Advantage Protect?
To ensure you don’t miss your chance to enroll in Blue Cross Medicare Advantage Protect, 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 Enroll in Blue Cross Medicare Advantage Protect
Getting started with Blue Cross Medicare Advantage Protect 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 Protect. 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 OK, TX
Website: | http://getbluetx.com/mapd |
---|---|
Formulary: | http://getbluetx.com/mapd/pharmacies |
Pharmacy: | Blue Cross and Blue Shield of OK, TX 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.
This page was last updated on .