Monthly premium
A sensible option if you already have prescription drug coverage elsewhere (such as the VA) but also want predictable costs on hospital and medical coverage plus built-in dental, vision, and hearing.
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Medical
- $0 Part B deductible
- $0 PCP visits
- $0-$30 specialist visits
- $0 labs
- $25 X-rays
- $0-$30 physical/speech/occupational therapy
Dental/Vision/Hearing
- $1,500/year dental benefit maximum
- $0 cost preventive and comprehensive dental
- No coverage for crowns
- $0 cost annual vision exam
- $150/year eyewear allowance
- $0 cost annual hearing exam
- Hearing aid coverage starting at $300 per ear
Extras
- $0-$40 fitness center membership
- Get $50/quarter over-the-counter (OTC) benefit for everyday health items
See if your doctor is in the network
Ambulance
$200 copay per trip
Dental Services
Medicare-covered
Preventive: $0
Comprehensive: $0
$1,500 limit on all covered preventive and comprehensive dental services. All preventative and comprehensive services must be provided by an in network plan contracted dentist.
Diabetes Supplies and Services
$0
You must use Abbott plan-designated monitors and test strips.
Diagnostic Tests, Lab and Radiology Services, and X-rays
$0 for lab services
$25 for X-rays
$50 for diagnostic tests
$0-$150 for high-tech radiology services (like MRIs)
Emergency Care
$130 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
$30 copay per visit
Hearing aids
$300-$1,775 copay per hearing aid (2 aids every year)
Outpatient Hospital/Surgery
Up to $200 copay per visit for ambulatory surgical center-based services
Up to $250 copay per visit for hospital-based services
Primary Care Provider Visit
$0 PCP copay per visit
Specialist Visit
$0-$30 copay per visit
Referral is required for specialist visits.
Vision Visit
Routine vision
$0
Non-routine vision
$30 copay per visit
Vision hardware
Our plan offers a $150/year allowance for vision hardware.
Preventive Care
$0
Inpatient Hospital Care
$275 copay per day for days 1-6
$0 Days 7+
Our plan covers an unlimited number of days for an in-network inpatient hospital stay.
Skilled Nursing Facility (SNF)
$0 copay per day for days 1-20
$218 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.
1The 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 Essential (HMO-POS), BlueCHiP for Medicare Enhanced (HMO-POS) BlueCHiP for Medicare Extra (HMO-POS), or the BlueCHiP for Medicare Access (HMO-POS) plan. If you select the BlueCHiP for Medicare Essential (HMO-POS), BlueCHiP for Medicare Enhanced (HMO-POS), BlueCHiP for Medicare Extra (HMO-POS), or the BlueCHiP for Medicare Access (HMO-POS) 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.
2A 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.