Medicare Advantage
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HMO-POS Network
BlueCHiP for Medicare
Value
Monthly premium
$0.00
Max Out-of-Pocket
$5,000
PCP Copay
$0/$30
Prescriptions
$0 - Tiers 1 and 2
PPO Network
HealthMate for Medicare
PPO
Monthly premium
$132.00
Max Out-of-Pocket
$4,250 combined
PCP Copay
$0/$10
Prescriptions
$0 - Tiers 1 and 2
HMO-POS Network
BlueCHiP for Medicare
Extra
Monthly premium
$107.00
Max Out-of-Pocket
$4,500
PCP Copay
$0/$10
Prescriptions
$0 - Tier 1; $4 - Tier 2
HMO Network
BlueCHiP for Medicare
Standard with Drugs
Monthly premium
$57.00
Max Out-of-Pocket
$4,500
PCP Copay
$0/$20
Prescriptions
$0 - Tiers 1 and 2
HMO Network
BlueCHiP for Medicare
Plus
Monthly premium
$151.00
Max Out-of-Pocket
$2,800
PCP Copay
$0/$5
Prescriptions
$3 - Tier 1; $6 - Tier 2
HMO-POS Network
BlueCHiP for Medicare
Preferred
Monthly premium
$264.00
Max Out-of-Pocket
$2,250
PCP Copay
$0/$5
Prescriptions
$3 - Tier 1; $6 - Tier 2
HMO Network
BlueCHiP for Medicare
Core
Monthly premium
$0.00
Max Out-of-Pocket
$3,500
PCP Copay
$0/$5
Prescriptions
Not Covered