BlueCHiP for Medicare Core

BlueCHiP for Medicare

Core

With a $0 monthly premium, this is a sensible option for those who want a comprehensive plan without prescription drug coverage and low, predictable out-of-pocket costs.

$0 monthly premium
$0 copay for PCMH PCP visits
$25 specialist visits
$0 labs/X-rays
$0 for routine hearing and vision screenings
$0 virtual doctors' visits 24/7
Dental coverage built in
$75/quarter over-the-counter (OTC) benefit (Flexible Benefit Card)
$200/year allowance for dental, hearing, and vision (Flexible Benefit Card)
$0 fitness benefit
$0 rides
$0 peer recovery services
$150 outpatient surgery copay
Hearing aids for $200-$1,675 copay per ear in-network
60 hours/year of household help

Need help?
Call 1-800-505-2583 (TTY: 711)

Monthly premium

$0^.00

Enroll now

Come back at the start of the Annual Election Period (October 15) to select and enroll in a plan.

What's covered

See if your doctor is in the network
Search providers

Medical & Hospital Benefits

Outpatient Care and Services^1,2

Ambulance

$150/trip

Dental Services

Preventive: $0
Comprehensive: 50% coinsurance

$1,500 limit on all covered dental services for preventive and comprehensive dental services. All preventive and comprehensive services must be provided by an in-network plan-contracted dentist.

Diabetes Supplies and Services

$0
You must use OneTouch plan-designated monitors and test strips.

Diagnostic Tests, Lab and Radiology Services, and X-Rays

$0 for lab services
$0 for diagnostic tests and X-rays
$130 for high-tech radiology services (for example, MRIs)

Emergency Care

$90 copay per visit
If you are admitted to the hospital within 24 hours, you do not have to pay your share of the cost for emergency care.

Hearing Services

Routine hearing: $0
Non-routine hearing: $25 copay per visit
Hearing aids:
$200-$1,675 copay per hearing aid (2 aids every 3 years)

Outpatient Hospital/Surgery

Up to $150 copay per visit

Primary Care Physician Visit

$0 PCMH or $5 non-PCMH copay per visit

Specialist Visit

$25 copay per visit
Referral is required for specialist visits.

Vision Visit

Routine vision: $0
Non-routine vision: $25 copay per visit
Vision hardware:
$200/year allowance for dental, hearing, and vision (Flexible Benefit Card)

Preventive Care

Inpatient Care^1,2

Inpatient Hospital Care

$180 copay per day for days 1-5, $0 Days 6+
Our plan covers an unlimited number of days for an inpatient hospital stay.

Skilled Nursing Facility

$0 copay per day for days 1-20
$130 copay per day for days 21-45
$0 copay per day for days 46-100
Our plan covers up to 100 days in a SNF.

¹ The out-of-pocket maximum includes only Medicare-covered services. This is the most a member would pay for these services during a calendar year. You must receive all routine care from plan providers unless you select the BlueCHiP for Medicare Value (HMO-POS), BlueCHiP for Medicare Extra, BlueCHiP for Medicare Preferred (HMO-POS), or the HealthMate for Medicare (PPO) plan. If you select the BlueCHiP for Medicare Value, BlueCHiP for Medicare Extra, BlueCHiP for Medicare Preferred, or the HealthMate for Medicare plan, with the exception of emergency or urgent care, ambulance, or dialysis services, it may cost more to get care from out-of-network providers.

² A preauthorization may be required. Review may include but is not limited to pre-authorization and/or continued treatment by the plan and/or plan designee. Contact Plan for details.