Florida blue medicare classic hmo

Florida blue medicare classic hmo DEFAULT

Blue Cross Medicare Advantage Plans

  • Typically have lower or $0 monthly premiums
  • Your care is handled by one primary care provider (PCP) who knows your health history
  • Your costs will be as low as possible when you see a provider in the network
  • You may be required to get a referral from your primary care physician prior to visiting a specialist
  • Includes drug coverage
  • A $0 monthly premium option is available
  • Flexibility to see doctors outside of the plan network in some cases
  • A predetermined copay rate, no coinsurance, to see doctors or specialists outside of the plan network
  • Includes drug coverage
  • Tend to have higher monthly premiums. $0 monthly premium options are available.
  • You are not required to select a PCP
  • Freedom to use doctors, hospitals, and providers outside of the network but you may pay higher copays and coinsurance
  • You will save money if you use doctors, hospitals, and other health care providers within the plan’s network
  • Includes drug coverage
Sours: https://www.bcbsil.com/medicare/blue-cross-medicare-options/mapd

BlueMedicare Classic Plus (HMO) 2021

Online Member Portal

A secure members only website that keeps you in control of your health and wellness with a variety of easy-to-use tools.

Fitness Program

SilverSneakers gives you unlimited access to over 14,000 gyms and wellness programs. Enjoy services like fitness classes, treadmills, weights, pools and more at no extra cost to you.

Case Management Coordination of Care

A dedicated consultant to assist with coordinating appointments, in or outpatient stays, management of chronic conditions and help with finding the best price on procedures and prescriptions.

Florida Blue Centers/FHCP Centers

Enjoy face-to-face customer service, wellness events and educational seminars at one of our unique retail centers.

Why Choose Blue
Sours: http://medicare.websales.floridablue.com/sbu/medadv-detail/bluemedicare-classic-plus-hmo-0?language_content_entity=en
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BlueMedicare Classic (HMO)

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Sours: https://www.healthpocket.com/medicare/plan/FL/florida-blue-medicare-inc/2021-bluemedicare-classic-hmo-k2kn9
Florida Blue Medicare Advantage HMO plans explained

Summary of Benefits for
2021 BlueMedicare Classic (HMO)


BlueMedicare Classic (HMO) H1035-020 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Florida Blue HMO available to residents in Florida. This plan includes additional Medicare prescription drug (Part-D) coverage. The BlueMedicare Classic (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $5,000 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,000 out of pocket. This can be a extremely nice safety net.

BlueMedicare Classic (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

Florida Blue HMO works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for BlueMedicare Classic (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Florida Blue HMO and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Florida Blue HMO except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.




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2021 Florida Blue HMO Medicare Advantage Plan Costs

Name:

BlueMedicare Classic (HMO)

Plan ID:

H1035-020

Provider:Florida Blue HMO
Year:2021
Type: Local HMO
Monthly Premium C+D: $0
Part C Premium: $0
MOOP: $5,000
Part D (Drug) Premium: $0
Part D Supplemental Premium $0
Total Part D Premium: $0
Drug Deductible: $0
Tiers with No Deductible:0
Gap Coverage:Yes
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan:H1035-021




BlueMedicare Classic (HMO) Part-C Premium

Florida Blue HMO plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.



H1035-020 Part-D Deductible and Premium

BlueMedicare Classic (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This Florida Blue HMO plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Florida Blue HMO above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.



Florida Blue HMO Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Florida Blue HMO plan does offer additional coverage through the gap.



H1035-020 Formulary or Drug Coverage

BlueMedicare Classic (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.








2021 BlueMedicare Classic (HMO) Summary of Benefits




Additional Benefits





Comprehensive Dental


Diagnostic servicesNot covered
EndodonticsNot covered
Extractions$0 copay
Non-routine servicesNot covered
PeriodonticsNot covered
Prosthodontics, other oral/maxillofacial surgery, other services$0 copay
Restorative servicesNot covered



Deductible





Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI)$100-250 copay
Diagnostic tests and procedures$0-100 copay
Lab services$0-35 copay
Outpatient x-rays$25-250 copay



Doctor Visits


Primary$0 copay
Specialist$35 copay per visit



Emergency care/Urgent Care


Emergency$90 copay per visit (always covered)
Urgent care$35 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment$40 copay
Routine foot careNot covered



Ground Ambulance





Hearing


Fitting/evaluation$0 copay
Hearing aids$0 copay
Hearing exam$35 copay



Inpatient Hospital Coverage


$225 per day for days 1 through 7
$0 per day for days 8 through 90
$0 per day for days 91 and beyond



Medical Equipment/Supplies


Diabetes supplies$0 copay
Durable medical equipment (e.g., wheelchairs, oxygen)0-20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item



Medicare Part B Drugs


Chemotherapy20% coinsurance
Other Part B drugs$5 copay or 20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric$300 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit$40 copay
Outpatient group therapy visit with a psychiatrist$40 copay
Outpatient individual therapy visit$40 copay
Outpatient individual therapy visit with a psychiatrist$40 copay



MOOP





Option





Optional supplemental benefits





Outpatient Hospital Coverage





Preventive Care





Preventive Dental


Cleaning$0 copay
Dental x-ray(s)$0 copay
Fluoride treatmentNot covered
Oral exam$0 copay



Rehabilitation Services


Occupational therapy visit$35 copay
Physical therapy and speech and language therapy visit$35 copay



Skilled Nursing Facility


$0 per day for days 1 through 20
$184 per day for days 21 through 100



Transportation





Vision


Contact lenses$0 copay
Eyeglass frames$0 copay
Eyeglass lenses$0 copay
Eyeglasses (frames and lenses)Not covered
OtherNot covered
Routine eye exam$0 copay
Upgrades$0 copay



Wellness Programs (e.g. fitness nursing hotline)






Reviews for BlueMedicare Classic (HMO) H1035



2019 Overall Rating
Part C Summary Rating
Part D Summary 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


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in BlueMedicare Classic (HMO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals


Health Plan Customer Service Rating for BlueMedicare Classic (HMO)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


BlueMedicare Classic (HMO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes



Ready to Enroll?

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Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST




Coverage Area for BlueMedicare Classic (HMO)

(Click county to compare all available Advantage plans)



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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit. Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

Sours: https://www.medicarehelp.org/2021-medicare-advantage/ma/bluemedicare-classic-hmo-H1035-020

Medicare classic blue hmo florida

2022 Medicare Advantage Plan Benefit Details for the BlueMedicare Classic (HMO)

— Plan Health Benefits —** Base Plan ** Premium• Health plan premium: $0 • Drug plan premium: $0 • You must continue to pay your Part B premium.• Part B premium reduction: NoDeductible• Health plan deductible: $0 • Other health plan deductibles: In-network: No • Drug plan deductible: No annual deductibleMaximum out-of-pocket enrollee responsibility (does not include prescription drugs)• $3 Optional supplemental benefits• No Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?• In-network: No Doctor visits• Primary: $0 copay • Specialist: $20 copay per visit (referral required) Diagnostic procedures/lab services/imaging• Diagnostic tests and procedures: $0-30 copay (authorization and referral required) • Lab services: $0-30 copay (authorization and referral required) • Diagnostic radiology services (e.g., MRI): $35-100 copay (authorization and referral required) • Outpatient x-rays: $10-100 copay (authorization and referral required) Emergency care/Urgent care• Emergency: $90 copay per visit (always covered) • Urgent care: $0-5 copay per visit (always covered) Inpatient hospital coverage• $155 per day for days 1 through 7
$0 per day for days 8 through 90
$0 per day for days 91 and beyond (authorization required) Outpatient hospital coverage• $50 copay per visit Skilled Nursing Facility• $0 per day for days 1 through 20
$160 per day for days 21 through 100 (authorization required) Preventive care• $0 copay Ground ambulance• $300 copay Rehabilitation services• Occupational therapy visit: $10-40 copay (authorization and referral required) • Physical therapy and speech and language therapy visit: $10-40 copay (authorization and referral required) Mental health services• Inpatient hospital - psychiatric: $195 per day for days 1 through 5
$0 per day for days 6 through 90 (authorization required) • Outpatient group therapy visit with a psychiatrist: $20 copay (authorization required) • Outpatient individual therapy visit with a psychiatrist: $20 copay (authorization required) • Outpatient group therapy visit: $20 copay (authorization required) • Outpatient individual therapy visit: $20 copay (authorization required) Opioid treatment program services• In-network: $20.00 copay (authorization required) Medical equipment/supplies• Durable medical equipment (e.g., wheelchairs, oxygen): 0-20% coinsurance per item (authorization required) • Prosthetics (e.g., braces, artificial limbs): 20% coinsurance per item (authorization required) • Diabetes supplies: $0 copay Dialysis• 20% coinsurance Hearing• Hearing exam: $20 copay (referral required) • Fitting/evaluation: $0 copay (limits apply, referral required) • Hearing aids: $0 copay (limits apply) Preventive dental• Oral exam: $0 copay (limits apply) • Cleaning: $0 copay (limits apply) • Fluoride treatment: Not covered• Dental x-ray(s): $0 copay (limits apply) Comprehensive dental• Non-routine services: Not covered• Diagnostic services: Not covered• Restorative services: Not covered• Endodontics: Not covered• Periodontics: Not covered• Extractions: $0 copay (limits apply, authorization required) • Prosthodontics, other oral/maxillofacial surgery, other services: $0 copay (limits apply, authorization required) Vision• Routine eye exam: $0 copay (limits apply, referral required) • Other: Not covered• Contact lenses: $0 copay (limits apply) • Eyeglasses (frames and lenses): Not covered• Eyeglass frames: $0 copay (limits apply) • Eyeglass lenses: $0 copay (limits apply) • Upgrades: $0 copay (limits apply) Medically-approved non-opioid pain management services• Chiropractic services: Not covered• Acupuncture: Not covered• Therapeutic Massage: Not covered• Alternative Therapies: Not coveredMore benefits• Transportation services: Some coverage• Transportation services for non-emergency care: Plan-approved locations: Not covered• Over-the-counter drug benefits: Not covered• Meals for short duration: Not covered• Annual physical exams: Not covered• Telehealth: Some coverage• WorldWide emergency coverage: Some coverage• WorldWide emergency urgent care: Some coverage• Fitness Benefit: Some coverage• In-Home Support Services: Some coverage• Bathroom Safety Devices: Not covered• Health Education: Some coverage• In-Home Safety Assessment: Not covered• Personal Emergency Response System (PERS): Not covered• Medical Nutrition Therapy (MNT): Not covered• Post discharge In-Home Medication Reconciliation: Not covered• Re-admission Prevention: Not covered• Wigs for Hair Loss Related to Chemotherapy: Not covered• Weight Management Programs: Not covered• Adult Day Health Services: Not covered• Nutritional/Dietary Benefit: Not covered• Home-Based Palliative Care: Not covered• Support for Caregivers of Enrollees: Some coverage• Additional Sessions of Smoking and Tobacco Cessation Counseling: Not covered• Enhanced Disease Management: Not covered• Telemonitoring Services: Not covered• Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline): Not covered• Counseling Services: Not coveredWellness programs (e.g., fitness, nursing hotline)• Covered Transportation• $0 copay (limits apply) Foot care (podiatry services)• Foot exams and treatment: $10 copay • Routine foot care: Not coveredMedicare Part B drugs• Chemotherapy: 20% coinsurance (authorization required) • Other Part B drugs: $5 copay or 20% coinsurance (authorization required)
Sours: https://q1medicare.com/MedicareAdvantage-PartC-MedicareHealthPlanBenefits.php?source=2021MARxFinder&countyCode=12086&state=FL&contractId=H1035&planId=017&segmentId=0&plan=BlueMedicare%20Classic%20(HMO)&utm_source=partd&utm_medium=rxfinder&utm_campaign=planname
Florida Blue Medicare Advantage HMO planes explicados

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