Blue Cross Blue Shield Ppo Copay
To Blue Cross and Blue Shield Member ID Cards A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. PPO in a Suitcase PPOB in a Suitcase No Suitcase Medicare Advantage Consumer-Directed Healthcare and Healthcare Debit Cards Introduction This guide. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Taking Action to Address Racial Health Disparities Learn how Blue Cross and Blue Shield companies are addressing our nation's. Arkansas Blue Cross and Blue Shield: Bronze Plan 1 PPO Coverage for: Individual/Family Plan Type: PPO 1 of 6 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. You pay a $65 emergency room copay (waived if you are admitted to the hospital or for an observation stay). Out-of-Pocket Maximum. This is the most you pay per plan year for covered health expenses before the plan pays 100 percent of covered expenses for the rest of the year. Read more about how Blue Cross of Idaho is dedicated to being the best choice for healthcare coverage at competitive prices. GeoBlue Medical Insurance for Travel Short-term and long-term international health plans are available for your urgent travel needs.
Our PPO managed health care plans provide for the payment of benefits at a higher level of coverage when the member utilizes our network of preferred providers. These network providers, including physicians, specialty care providers, hospitals, and other health care facilities and practitioners, have contracted with BCBSTX to provide health care services at negotiated rates.
If the member elects to receive care from network providers:
- They will receive the higher level of benefits (In-Network Benefits)
- They are not required to file claim forms — Network providers bill BCBSTX for services provided
- They are not balance billed — Network providers will not bill for costs that are in excess of the BCBSTX allowable amount for covered services.
- Network providers are responsible for any necessary preauthorization
If the member elects to receive care from providers outside of the network, they may choose:
| ParPlan Providers Providers participating in a direct-payment arrangement with BCBSTX | Out-of-Network Providers Non-contracting providers |
|---|---|
If the member elects to receive care from a ParPlan Provider, benefits for covered services are available at the lower level of benefits (Out-of-Network); however…
| If the member elects to receive care from a non-contracting provider, benefits for covered services are available at the lower level of benefits (Out-of-Network); and…
|
The PPO plan is available to clients through the Blue ChoiceSM Network, one of the largest networks in Texas. Blue ChoiceSM provides:
- Access to the national BlueCard® network when members are outside of Texas
- Over 600 participating hospitals and facilities in Texas
- More than 800,000 doctors and 6,000 hospitals contracting with Blue Cross and Blue Shield plans nationwide
For health care services required outside of Texas, members have access to the BlueCard national network of providers.
BCBSTX offers a variety of PPO plans with varying deductible, coinsurance and copayment amount options. All plans include an outpatient prescription drug benefit with either a three-tier or four-tier pharmacy copay design.
The three-tier pharmacy copay plan design includes three tiers of medications that are comprised of:
- Generic Drugs
- Preferred Brand-name Drugs
- Non-preferred Brand-name Drugs
The four-tier pharmacy copay plan design includes four tiers of medications that are comprised of:
- Generic
- Preferred Brand-name Drugs
- Non-preferred Brand-name / Preferred Specialty
- Non-preferred Specialty Drugs
Prescription drugs are available through retail pharmacies throughout Texas and mail order pharmacy services.
For more detailed information on available benefit designs, a description of the services and supplies that are covered, a listing of those services and supplies that are limited or excluded, terms and general administration or for any questions you may have regarding our products and services, contact us for the phone number of the regional sales office near you.
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Blue Cross Medicare Advantage Choice Plus (PPO) H1666-006 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Blue Cross and Blue Shield of Texas available to residents in Texas. This plan includes additional Medicare prescription drug (Part-D) coverage. The Blue Cross Medicare Advantage Choice Plus (PPO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $7,550 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,550 out of pocket. This can be a extremely nice safety net.
Blue Cross Medicare Advantage Choice Plus (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of 'preferred' providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.
Blue Cross and Blue Shield of Texas works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Blue Cross Medicare Advantage Choice Plus (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Blue Cross and Blue Shield of Texas 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 Blue Cross and Blue Shield of Texas 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 Blue Cross and Blue Shield of Texas Medicare Advantage Plan Costs
| Name: | |
|---|---|
| Plan ID: | H1666-006 |
| Provider: | Blue Cross and Blue Shield of Texas |
| Year: | 2021 |
| Type: | Local PPO |
| Monthly Premium C+D: | $0 |
| Part C Premium: | $0 |
| MOOP: | $7,550 |
| Part D (Drug) Premium: | $0 |
| Part D Supplemental Premium | $0 |
| Total Part D Premium: | $0 |
| Drug Deductible: | $445.0 |
| Tiers with No Deductible: | 1 |
| Gap Coverage: | Yes |
| Benchmark: | not below the regional benchmark |
| Type of Medicare Health: | Enhanced Alternative |
| Drug Benefit Type: | Enhanced |
| Similar Plan: | H1666-008 |
Blue Cross Medicare Advantage Choice Plus (PPO) Part-C Premium
Blue Cross and Blue Shield of Texas 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.
H1666-006 Part-D Deductible and Premium
Blue Cross Medicare Advantage Choice Plus (PPO) has a monthly drug premium of $0 and a $445.0 drug deductible. This Blue Cross and Blue Shield of Texas 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 Blue Cross and Blue Shield of Texas 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.
Blue Cross and Blue Shield of Texas 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 Blue Cross and Blue Shield of Texas plan does offer additional coverage through the gap.
H1666-006 Formulary or Drug Coverage
Blue Cross Medicare Advantage Choice Plus (PPO) 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 Blue Cross Medicare Advantage Choice Plus (PPO) Summary of Benefits
Additional Benefits
| No |
|---|
Comprehensive Dental
| Diagnostic services | Not covered |
|---|---|
| Endodontics | Not covered |
| Extractions | Not covered |
| Non-routine services | Not covered |
| Periodontics | Not covered |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
| Restorative services | Not covered |
Deductible
| $750 annual deductible |
|---|
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | 50% coinsurance (Out-of-Network) |
|---|---|
| Diagnostic radiology services (e.g., MRI) | $300-325 copay |
| Diagnostic tests and procedures | 50% coinsurance (Out-of-Network) |
| Diagnostic tests and procedures | $0-100 copay |
| Lab services | $5-50 copay |
| Lab services | 50% coinsurance (Out-of-Network) |
| Outpatient x-rays | 50% coinsurance (Out-of-Network) |
| Outpatient x-rays | $5-100 copay |
Doctor Visits
| Primary | 50% coinsurance per visit (Out-of-Network) |
|---|---|
| Primary | $20 copay per visit |
| Specialist | $50 copay per visit |
| Specialist | 50% coinsurance per visit (Out-of-Network) |
Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
|---|---|
| Urgent care | $40 copay per visit (always covered) |
Foot Care (podiatry services)
| Foot exams and treatment | $45 copay |
|---|---|
| Foot exams and treatment | 50% coinsurance (Out-of-Network) |
| Routine foot care | Not covered |
Blue Cross Blue Shield Ppo Copay
Ground Ambulance
| $300 copay (Out-of-Network) |
|---|
| $300 copay |
Hearing
| Fitting/evaluation | Not covered |
|---|---|
| Hearing aids - inner ear | Not covered |
| Hearing aids - outer ear | Not covered |
| Hearing aids - over the ear | Not covered |
| Hearing exam | $50 copay |
| Hearing exam | 50% coinsurance (Out-of-Network) |
Inpatient Hospital Coverage
| $372 per day for days 1 through 5 $0 per day for days 6 through 90 |
|---|
| 50% per stay (Out-of-Network) |
Medical Equipment/Supplies
| Diabetes supplies | 20% coinsurance per item (Out-of-Network) |
|---|---|
| Diabetes supplies | 0-20% coinsurance per item |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Out-of-Network) |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Out-of-Network) |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
Medicare Part B Drugs
| Chemotherapy | 50% coinsurance (Out-of-Network) |
|---|---|
| Chemotherapy | 20% coinsurance |
| Other Part B drugs | 50% coinsurance (Out-of-Network) |
| Other Part B drugs | 20% coinsurance |
Mental Health Services
| Inpatient hospital - psychiatric | 50% per stay (Out-of-Network) |
|---|---|
| Inpatient hospital - psychiatric | $270 per day for days 1 through 6 $0 per day for days 7 through 90 |
| Outpatient group therapy visit | 50% coinsurance (Out-of-Network) |
| Outpatient group therapy visit | $30 copay |
| Outpatient group therapy visit with a psychiatrist | $30 copay |
| Outpatient group therapy visit with a psychiatrist | 50% coinsurance (Out-of-Network) |
| Outpatient individual therapy visit | $30 copay |
| Outpatient individual therapy visit | 50% coinsurance (Out-of-Network) |
| Outpatient individual therapy visit with a psychiatrist | $30 copay |
| Outpatient individual therapy visit with a psychiatrist | 50% coinsurance (Out-of-Network) |
MOOP
| $11,300 In and Out-of-network $7,550 In-network $11,300 Out-of-network |
|---|
Option
| No |
|---|
Optional supplemental benefits
| No |
|---|
Outpatient Hospital Coverage
| 50% coinsurance per visit (Out-of-Network) |
|---|
| $325 copay per visit |
Preventive Care
| $0 copay |
|---|
| 50% coinsurance (Out-of-Network) |
Preventive Dental
| Cleaning | Not covered |
|---|---|
| Dental x-ray(s) | Not covered |
| Fluoride treatment | Not covered |
| Oral exam | Not covered |
Rehabilitation Services
| Occupational therapy visit | 50% coinsurance (Out-of-Network) |
|---|---|
| Occupational therapy visit | $40 copay |
| Physical therapy and speech and language therapy visit | 50% coinsurance (Out-of-Network) |
| Physical therapy and speech and language therapy visit | $40 copay |
Skilled Nursing Facility
| 50% per stay (Out-of-Network) |
|---|
| $0 per day for days 1 through 20 $184 per day for days 21 through 100 |
Transportation
| Not covered |
|---|
Vision
| Contact lenses | Not covered |
|---|---|
| Eyeglass frames | Not covered |
| Eyeglass lenses | Not covered |
| Eyeglasses (frames and lenses) | Not covered |
| Other | Not covered |
| Routine eye exam | $0 copay |
| Routine eye exam | $0 copay (Out-of-Network) |
| Upgrades | Not covered |
Wellness Programs (e.g. fitness nursing hotline)
| Covered |
|---|
Reviews for Blue Cross Medicare Advantage Choice Plus (PPO) H1666
| 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 Blue Cross Medicare Advantage Choice Plus (PPO) 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 Blue Cross Medicare Advantage Choice Plus (PPO)
| Total Customer Service Rating |
|---|
| Reviewing Appeals Decisions |
| Call Center, TTY, Foreign Language |
Blue Cross Medicare Advantage Choice Plus (PPO) 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
Blue Cross Blue Shield Ppo Deductible Texas
| 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?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for Blue Cross Medicare Advantage Choice Plus (PPO)
(Click county to compare all available Advantage plans)
| State: | Texas |
|---|---|
| County: | Chambers,Colorado,Fort Bend,Galveston,Hardin, Harris,Jefferson,Liberty,Matagorda, Montgomery,Wharton, |
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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.