Medicare Plus Blue PPO Essential | 2022 Plans (2023)

  • Overview
  • Medical
  • Prescriptions
  • Dental, Vision, Hearing
  • Documents

Overview

Deductible

Medical

In-network services: $0Out-of-network services: $0

Pharmacy

Most generic drugs: $0All other drugs: $0

Out-of-pocket maximum

In-network services: $6,000

Combined in- and out-of-network services: $6,000

Optional supplemental benefits don't count toward your out-of-pocket maximum.

Office visits

Primary care physician

You pay $0.

Specialist

You pay $45.

Urgent care

You pay $0-$50

Pharmacy

Copays start at $0 for certain generic drugs filled at a preferred network pharmacy. Some drugs may cost more if you choose a pharmacy in our standard network.

Find your pharmacy.

Drug list

See if this plan covers your medication. Find your prescription (PDF).

You get more than Original Medicare

All benefits required by Original Medicare and more, including:

• $0 telehealth visits for primary care and behavioral health• Advantage Dollars quarterly allowance for over-the-counter drugs, groceries and health products• Hearing aid allowance every 3 years• Two dental exams and cleanings and one vision exam each year• Worldwide emergency, urgent care and transportation coverage• Meals benefit following hospital discharge for qualifying members • Transportation benefit for certain counties following hospital discharge• In-Home Support benefit for qualifying members• SilverSneakers® fitness program• Part D prescription drug coverage• LASIK and radial keratotomy surgery for a $45 copay when you stay in network.• Coverage while traveling outside of Michigan with the The nationwide network of Blue Plan Providers program (PDF).

Medical

Doctor and hospital choice

This is a PPO plan. PPO stands for preferred provider organization. It's a group of health care professionals that provide services to members. You can choose the doctors you want to see, but pay less when you see a doctor in our network. Find a doctor in this plan's network.

Preventive services

Includes services such as:• Welcome to Medicare exam• Personalized prevention plan services• Bone mass measurement• Screenings for cancer, glaucoma, depression, diabetes and sexually transmitted infections• Immunizations (including flu, pneumonia and Hepatitis B vaccines)• Screening mammograms• Pap smears• Behavioral counseling to reduce alcohol misuse• Behavioral therapy for cardiovascular disease and obesity

You pay $0

Doctor office visits

In network

Primary care physician: $0 copay.

Specialists: You pay a $45 copay.

Out of network

You pay a $25 copay.

Specialists: You pay a $50 copay.

(Video) 2022 Example Medicare Advantage PPO Plan

Online Visits

In network

Medical: You pay a $0 copay.

Behavioral health: You pay a $0 copay.

Out of network

You pay 50% of the cost.

Outpatient surgery

In network

Ambulatory surgical center: You pay a $0-$125 copay.

Hospital: You pay a $150-$275 copay.

Out of network

You pay 50% of the cost.

Inpatient hospital care

In network

Days 1-6: You pay a $325 copay per day.

Days 7-90: You pay $0.

Days 90 and beyond: You pay $0.

Out of network

You pay 50% of the cost.

Skilled nursing facility

You're covered for up to 100 days each benefit period at a Medicare-certified facility.

In network

Days 1-20: You pay a $0 copay per day.

Days 21-100: You pay a $188 copay per day.

Out of network

You pay 50% of the cost.

Urgent care

In network

You pay a $0-$50 copay.

Out of network

You pay a $0-$50 copay.

Emergency care

In network

You pay a $90 copay.

Out of network

You pay a $90 copay.

Worldwide urgent care

There's a combined $50,000 lifetime limit for emergency and urgent care services received outside the U.S. and its territories.

There's a combined $250 deductible for urgent care outside the U.S. You pay a $50 copay after deductible.

Worldwide emergency care

There's a combined $50,000 lifetime limit for emergency and urgent care services received outside the U.S. and its territories.

There's a combined $250 deductible for emergency care outside the U.S. You pay a $90 copay after deductible.

(Video) Top Medicare Advantage plans 2022 | Aetna | Blue Cross | Humana

Worldwide emergency transportation

There's a combined $50,000 lifetime limit for emergency and urgent care services received outside the U.S. and its territories.

There's a combined $250 deductible for emergency transportation outside the U.S. You pay a $275 copay after deductible.

Durable medical equipment

In network

You pay 0%-20% of the cost.

Out of network

You pay 0%-50% of the cost.

Ambulance services

In network

Emergency: You pay a $275 copay.

Out of network

Emergency: You pay a $275 copay.

Non-emergency: You pay 50% of the cost.

Chiropractic services

In network

Spinal manipulation: You pay a $20 copay.

X-rays, one set per year: You pay a $35 copay.

Out of network

You pay 50% of the cost for x-rays.

Podiatry services

In network

You pay a $45 copay.

Out of network

You pay 50% of the cost.

Outpatient behavioral health services

Includes individual and group therapy visits.

In network

You pay a $40 copay.

Out of network

You pay 50% of the cost.

Occupational, physical and speech therapy

In network

You pay a $40 copay.

Out of network

You pay 50% of the cost.

Renal dialysis

In network

You pay a 20% copay.

Out of network

You pay 50% of the cost.

Prescriptions

Pharmacy deductible

This plan doesn't have a pharmacy deductible. You can save by going to a preferred pharmacy in our network. Check out the example of what you'll pay for a one-month supply at a preferred pharmacy compared with a standard pharmacy.

(Video) Best Medicare Advantage Plans - 2022 - HMO vs PPO

Initial coverage: Before costs reach $4,430

Tier 1: Preferred generic drugs

Commonly prescribed generic versions of brand medications. You’ll pay the least for these drugs at the pharmacy.

Preferred pharmacy: You pay $0.

Standard pharmacy: You pay $5.

Tier 2: Generic drugs

Although you’ll pay more at the pharmacy for these generic drugs, they're more cost-effective than brand medications.

Preferred pharmacy: You pay $11.

Standard pharmacy: You pay $20.

Tier 3: Preferred brand drugs

Brand drugs that aren’t available yet as a generic.

Preferred pharmacy: You pay $42.

Standard pharmacy: You pay $47.

Tier 4: Non-preferred drugs

Because there are alternatives for the drugs in this tier, you’ll pay more for them at the pharmacy.

Preferred pharmacy: You pay 50% of the cost.

Standard pharmacy: You pay 50% of the cost.

Tier 5: Specialty drugs

Specialty drugs are used to treat complex conditions like cancer and multiple sclerosis. Although they can be generic or brand, they usually need special handling and approval. You may have to order them through a specialty pharmacy.

Preferred pharmacy: You pay 33% of the cost.

Standard pharmacy: You pay 33% of the cost.

Coverage gap: When costs are $4,430 - $7,050

Tier 1: You also receive some coverage for generic drugs. You pay no more than 25% of the cost for generic drugs and the plan pays the rest.

All other drugs: You pay 25% of the cost.

Catastrophic coverage: When costs are more than $7,050

Generic drugs: You pay a $3.95 copay or 5% of the cost, whichever is greater.Other drugs: You pay an $9.85 copay or 5% of the cost, whichever is greater.

Dental, Vision, Hearing

Dental

This plan covers these preventive services for $0 copay:

• Two oral exams every year
• Two routine cleanings every year
• X-Rays: One bitewing set or up to 6 periapical films every 2 years
• Flouride Treatment

What's not covered:

• Dental procedures like fillings, crowns, root canals and simple extractions

Add more dental and vision coverage for an additional cost.

Vision

This plan covers these benefits:

Vision exams

• One routine eye exam every year for a $0 copay. You can choose any provider from the VSP Choice network.

Glasses and contacts

• We'll pay $100 combined max allowance per year used for elective contact lenses or one pair of frames.
• Eyeglass lenses are covered in full once per year.
• Limitations may apply.
• $0 copay for one pair of Medicare-covered glasses or contact lenses after cataract surgery.

LASIK

• You pay a $45 copay for LASIK or RK (radial keratotomy) surgery.

This plan also covers Medicare-covered exams. You'll just have a $45 copay.
Diabetic Retinopathy Eye Exam has a $0 copay.

(Video) 2022 Humana Group Medicare Advantage PPO Plan Retiree Video

How this compares:

• This plan offers more vision coverage than Original Medicare.

Add more dental and vision and hearing coverage for an additional cost.

Hearing

You pay:

• $0 for one hearing aid fitting and evaluation every three years
• $0 to $45 copay for one routine hearing exam each year
• $0 to $45 copay for Medicare-covered diagnostic hearing exams
• New standard hearing aids every three years. We'll cover up to $750 per ear.

How this compares:

• This plan offers more vision coverage than Original Medicare.

Add more dental and vision coverage for an additional cost.

Documents

Learn more about this plan

This document lists important features and rules for this plan.

Summary of Benefits (PDF)

This booklet explains how to use this plan's benefits. It also lists some of the things this plan doesn't cover.

Evidence of Coverage (PDF)

This brochure gives you an overview of all our Medicare Advantage plans to help you compare.

2022 Medicare Advantage Plans Comparison Guide (PDF)

Find a doctor or pharmacy

Find a doctor or hospital in this plan's network:

Find a doctor

Find a pharmacy in this plan's network:

Find a pharmacy

Do you qualify for help?

If you meet certain income and resource limits, you may qualify for help paying for your prescription drug costs through the low-income subsidy.

If you're eligible, see what your monthly premium would be:

Medicare Plus Blue PPO Premium Summary Table (PDF)

Ready to enroll?

The easiest way to enroll in this plan is online. Or call us at 1-888-563-3307. TTY users call 711. You can also print, fill out and mail this paper application.

Enrollment Application Form (PDF)

Looking for a form or document you don't see here?

Visit our Help section.

Medicare Plus Blue PPO Essential | 2022 Plans (1)

Looking for extra dental and vision coverage?

You can add an optional supplemental package to your Medicare Advantage plan for an additional monthly cost.
This package will enhance your dental and vision benefits.It offers:

  • Extra coverage for dental work including fillings, fluoride treatments and root canals
  • A generous allowance for elective contact lenses or glasses (lenses and frames)

You can add a coverage package when you enroll in your plan.
Learn more by reading the Optional Supplemental Brochure (PDF).

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Still have questions? We have answers.

Use our Frequently Asked Questions to learn which plan will fit your needs.

  • How do I know what coverage is right for me?
  • How can I get help paying for my Medicare coverage?
  • How is Medicare different from other health insurance?
(Video) 2022 Medicare Advantage Feature Plans

FAQs

Who Has the Best Medicare Advantage Plan for 2022? ›

For 2022, Kaiser Permanente ranks as the best-rated provider of Medicare Advantage plans, scoring an average of 5 out of 5 stars. Plans are only available in seven states and the District of Columbia.

What is Medicareplus? ›

The Medicare Plus Card offers discounts on prescription drugs, dental, vision and hearing care. To use the card, you must find a pharmacy, dentist, eye doctor or hearing doctor who will accept the card and apply the discount to your appointment or product.

What is the biggest disadvantage of Medicare Advantage? ›

Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.

What are the five best Medicare Advantage plans? ›

Here's a rundown of the top Medicare Advantage plans in 2022.
  • Best for size of network: UnitedHealthcare Medicare Advantage.
  • Best for extra perks: Aetna Medicare Advantage.
  • Best for member satisfaction: Kaiser Permanente Medicare Advantage.
  • Best for low-cost plan availability: Humana Medicare Advantage.
Dec 21, 2021

What is Medicare Plus Blue PPO? ›

With Medicare Plus Blue Group PPO, you'll get nationwide coverage and low out-of-pocket costs. With your plan, you'll be able to choose any doctor or hospital that accepts Medicare. You can check with your group plan's administrator for details on your coverage.

Can I drop my Medicare Advantage plan and go back to original Medicare? ›

Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year.

How much does Medicare Plus cost? ›

Average Cost of Medicare Advantage Plans in Each State
StateMonthly PremiumPrescription Drug Deductible
California$48$377
Colorado$49$343
Connecticut$79$318
Delaware$64$239
46 more rows
Mar 21, 2022

Is Humana a good Medicare Advantage plan? ›

Mixed reviews: Humana ranks fourth-highest in J.D. Power's 2021 Medicare Advantage member satisfaction survey, and the National Committee for Quality Assurance gives several Humana plans a 3 or below out of 5 on its ratings scale.

Which is better PPO or HMO? ›

HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.

Can you have Medicare and Humana at the same time? ›

People eligible for Medicare can get coverage through the federal government or through a private health insurance company like Humana. Like Medicaid, every Medicare plan is required by law to give the same basic benefits.

What's the difference between a Medicare Advantage plan and a Medicare supplement plan? ›

A Medicare Advantage plan (Medicare Part C) is structured to be an all-in-one option with low monthly premiums. Medicare Supplement plans offer additional coverage to Original Medicare with low to no out-of-pocket costs.

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