Blue Essential Blue Cross Blue Shield Compare Insurance Plans
Plan Overview
Blue Medicare Advantage Essential is our most popular plan with a $0 monthly premium, $0 medical and prescription drug deductibles and a low maximum out-of-pocket of $3,425 for in-network and out-of-network costs. You get hospital, medical and prescription drug coverage, plus valuable extra benefits, all in one plan.
Blue KC makes it flexible for you to use your plan as you decide. The new Blue Benefit Bucks works like a debit card so it's simple to use and you have the power to spend it based on your personal needs.
The Essential plan comes loaded with a $500 per year benefit allowance to use for eyewear and transportation. Plus, we'll load your $100 per quarter over-the-counter (OTC) allowance and healthy activity rewards1 on the same card. Your OTC allowance accumulates throughout the year, but must be spent by the end of the year.
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Advantages Include
- $0 monthly premium
- $0 medical and prescription drug deductibles
- $0 Primary care physician copay
- $0 Tier 1 and Tier 2 Prescription Drugs, up to 100-day supply
- $1,000 dental benefit, each year
- $0 hearing aids, and services for Level 1 devices, a $500 benefit per ear, annually
- $100 over-the-counter items allowance, every 3 months
- $500 Blue Benefit Bucks, flexible benefits for eyewear and transportation combined
- 40 hours per year for Member and Caregiver support for help to appointments or around the house
- Meals support for chronic conditions
- Low $3,425 annual out-of-pocket maximum in and out of network
- SilverSneakers® fitness membership at no additional cost
You won't need to choose a Primary Care Physician (PCP) or get a referral to see a specialist. By seeing preferred providers, you'll make the most of your benefits, but you also have the freedom to go out-of-network for care at a higher rate. You have worldwide emergency and urgent care coverage plus travel benefits with access to national BCBS network of providers.
To join, you must be entitled to Medicare Part A, be enrolled in Medicare Part B, and live in our service area. The Blue KC service area includes these counties in Kansas: Johnson and Wyandotte. And these counties in Missouri: Andrew, Bates, Buchanan, Cass, Clay, Clinton, Jackson, Johnson, Lafayette, Platte and Ray.
1Rewards for healthy activities may not be used for any benefit cost sharing.
4-Star PPO plan options
We're proud to announce that our PPO plans earned a 4 out of 5-Star rating from the Centers for Medicare & Medicaid Services (CMS). So, when it comes to quality and performance, Blue KC really shines.
Every year, Medicare evaluates plans based on a 5-star rating system.
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Plan Benefits
At-A-Glance
You must continue to pay Part B premium
| Total Premium | $0 | |
|---|---|---|
| Blue National Network | Covered | |
| Plan Deductible | $0 | |
| Maximum Out of Pocket (MOOP) | $3,425 | |
Inpatient Services | ||
| Inpatient Hospital - Acute | In-Network$325/day, Days 1-5 | Out-of-Network45% per stay |
| Skilled Nursing Facility | In-Network$20/day, Days 1-20 | Out-of-Network45%, Days 1-100 |
Emergency Care/Urgent Care | ||
| Emergency Care (Worldwide) | In-Network$120 | Out-of-Network$120 |
| Urgently Needed Care (Worldwide) | In-Network$50 | Out-of-Network$50 |
| Ambulance Services (Worldwide) | In-Network$300 | Out-of-Network$300 |
Professional Services | ||
| PCP Visit | In-Network$0 | Out-of-Network$25 |
| Specialist Visit | In-Network$25 | Out-of-Network$50 |
| Telehealth | In-Network$0 | Out-of-NetworkN/A |
Diagnostic Testing Services | ||
| Diagnostic Procedures/Tests | In-Network$0 | Out-of-Network45% |
| Lab Services | In-Network$0 | Out-of-Network45% |
| X-Ray Services | In-Network$0 | Out-of-Network45% |
| MRI/CT at physicians office or free standing | In-Network$100 | Out-of-Network45% |
| MRI/CT at other facility | In-Network$250 | Out-of-Network45% |
Outpatient Services | ||
| Observation | In-Network$325 | Out-of-Network45% |
| Outpatient Hospital & ASC (Minor surgical; other services) | In-Network20% | Out-of-Network45% |
| Surgery (Ambulatory Surgical Center) | In-Network$250 | Out-of-Network45% |
| Surgery (Outpatient Hospital) | In-Network$325 | Out-of-Network45% |
Supplemental Services | ||
| Dental | In-Network$0 copay, 2 exams/cleaning, 1 X-ray/fluoride; 50% coinsurance for comprehensive | Out-of-Network50% coinsurance preventive services; 50% coinsurance for comprehensive |
| $1,000 benefit max for preventive and comprehensive In- and Out-of-Network combined | ||
| Eyewear & Transportation | $500 Blue Benefit Bucks for transportation and eyewear combined | |
| Hearing and Hearing Aids | $0 hearing exam; up to $500 per ear per year for hearing aids | |
| Over-the-counter allowance | $100 per quarter | |
*After 90 days, our plan covers an unlimited number of additional days for an inpatient hospital stay at $0 copay.
Prescription Drug Benefits
| Annual Deductible | $0 | |
|---|---|---|
| Preferred Generics (Tier 1) | 30-day Supply$0 copay | 100-day Supply$0 copay |
| Generics (Tier 2) | 30-day Supply$10 copay | 100-day Supply$0 copay |
| Preferred Brands (Tier 3) | 30-day Supply$47 copay | 90-day Supply$141 copay |
| Non-Preferred Drugs (Tier 4) | 30-day Supply$100 copay | 90-day Supply$300 copay |
| Specialty Drugs (Tier 5) | 30-day Supply33% | 90-day SupplyN/A |
| Gap Coverage | Original Medicare Standard: 25% for all Tiers | |
| $35 Insulin Program | Yes | |
We offer a 100-day mail order and retail drug benefit with a $0 copay for all Tier 1 and Tier 2 prescription drugs.
This information is not a complete description of benefits.
Source: https://www.medicarebluekc.com/plans/essential
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