- Bcbs Core Plan Ppo
- What Is The Copay For Blue Cross Blue Shield
$50 copay retail/ $100 copays for 90 day maintenance drug mail order None If you have outpatient surgery 30% Facility fee (e.g., ambulatory surgery center) $35 copay/visit after deductible 30% coinsurance after deductible None Physician/surgeon fees $20 copay/visit for PCP and specialist after deductible $25 copay/visit for. BlueCare All Copay 1565 Plans. Florida Blue provides Plan Brochures and Summaries of Benefits and Coverage (SBC) for each of our plans. These documents highlight key features of your plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions.
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CareFirst BlueCross BlueShield Advantage Core (HMO) H6067-001 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by CareFirst BlueCross BlueShield Medicare Advantage available to residents in Maryland. This plan includes additional Medicare prescription drug (Part-D) coverage. The CareFirst BlueCross BlueShield Advantage Core (HMO) has a monthly premium of $35.00 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.
CareFirst BlueCross BlueShield Advantage Core (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.
CareFirst BlueCross BlueShield Medicare Advantage works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for CareFirst BlueCross BlueShield Advantage Core (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from CareFirst BlueCross BlueShield Medicare Advantage 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 CareFirst BlueCross BlueShield Medicare Advantage 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 CareFirst BlueCross BlueShield Medicare Advantage Medicare Advantage Plan Costs
| Name: | CareFirst BlueCross BlueShield Advantage Core (HMO) |
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| Plan ID: |
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| Provider: | CareFirst BlueCross BlueShield Medicare Advantage |
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| Year: | 2021 |
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| Type: | Local HMO |
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| Monthly Premium C+D: | $35.00 |
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| Part C Premium: | $20.00 |
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| MOOP: | $7,550 |
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| Part D (Drug) Premium: | $15.00 |
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| Part D Supplemental Premium | $0 |
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| Total Part D Premium: | $15.00 |
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| Drug Deductible: | $0 |
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| Tiers with No Deductible: | 0 |
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| Gap Coverage: | No |
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| Benchmark: | not below the regional benchmark |
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| Type of Medicare Health: | Enhanced Alternative |
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| Drug Benefit Type: | Enhanced |
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| Similar Plan: | H6067-002 |
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CareFirst BlueCross BlueShield Advantage Core (HMO) Part-C Premium
CareFirst BlueCross BlueShield Medicare Advantage plan charges a $20.00 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.
H6067-001 Part-D Deductible and Premium
CareFirst BlueCross BlueShield Advantage Core (HMO) has a monthly drug premium of $15.00 and a $0 drug deductible. This CareFirst BlueCross BlueShield Medicare Advantage plan offers a $15.00 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 CareFirst BlueCross BlueShield Medicare Advantage 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 $15.00. 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.
CareFirst BlueCross BlueShield Medicare Advantage 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 CareFirst BlueCross BlueShield Medicare Advantage plan does not offer additional coverage through the gap.
Premium Assistance
The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The CareFirst BlueCross BlueShield Advantage Core (HMO) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $3.70 for 75% low income subsidy $7.50 for 50% and $11.20 for 25%.
| Full LIS Premium: | $0 |
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| 75% LIS Premium: | $3.70 |
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| 50% LIS Premium: | $7.50 |
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| 25% LIS Premium: | $11.20 |
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H6067-001 Formulary or Drug Coverage
CareFirst BlueCross BlueShield Advantage Core (HMO) 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 CareFirst BlueCross BlueShield Advantage Core (HMO) Summary of Benefits
Additional Benefits
Comprehensive Dental
| Diagnostic services | Not covered |
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| Endodontics | Not covered |
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| Extractions | Not covered |
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| Non-routine services | Not covered |
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| Periodontics | Not covered |
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| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
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| Restorative services | Not covered |
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Deductible
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $200 copay |
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| Diagnostic tests and procedures | $50 copay |
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| Lab services | $0 copay |
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| Outpatient x-rays | $20 copay |
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Doctor Visits
| Primary | $5 copay per visit |
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| Specialist | $50 copay per visit |
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Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
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| Urgent care | $30 copay per visit (always covered) |
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Foot Care (podiatry services)
Bcbs Core Plan Ppo
| Foot exams and treatment | $40 copay |
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| Routine foot care | Not covered |
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Ground Ambulance
Hearing
| Fitting/evaluation | $0 copay |
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| Hearing aids | $475-1,950 copay |
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| Hearing exam | $40 copay |
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What Is The Copay For Blue Cross Blue Shield
Inpatient Hospital Coverage
$350 per day for days 1 through 5
$0 per day for days 6 through 90 |
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Medical Equipment/Supplies
| Diabetes supplies | $0 copay per item |
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| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
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| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
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Medicare Part B Drugs
| Chemotherapy | 20% coinsurance |
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| Other Part B drugs | 20% coinsurance |
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Mental Health Services
| Inpatient hospital - psychiatric | $330 per day for days 1 through 5
$0 per day for days 6 through 90 |
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| Outpatient group therapy visit | $20 copay |
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| Outpatient group therapy visit with a psychiatrist | $20 copay |
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| Outpatient individual therapy visit | $40 copay |
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| Outpatient individual therapy visit with a psychiatrist | $40 copay |
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MOOP
Option
Optional supplemental benefits
Outpatient Hospital Coverage
Preventive Care
Preventive Dental
| Cleaning | $30 copay |
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| Dental x-ray(s) | $30 copay |
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| Fluoride treatment | $30 copay |
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| Oral exam | $30 copay |
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Rehabilitation Services
| Occupational therapy visit | $30 copay |
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| Physical therapy and speech and language therapy visit | $30 copay |
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Skilled Nursing Facility
$0 per day for days 1 through 20
$180 per day for days 21 through 100 |
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Transportation
Vision
| Contact lenses | $0 copay |
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| Eyeglass frames | $0 copay |
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| Eyeglass lenses | $20 copay |
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| Eyeglasses (frames and lenses) | Not covered |
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| Other | $0 copay |
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| Routine eye exam | $20 copay |
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| Upgrades | Not covered |
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Wellness Programs (e.g. fitness nursing hotline)
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for CareFirst BlueCross BlueShield Advantage Core (HMO)
(Click county to compare all available Advantage plans)
| State: | Maryland
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| County: | Anne Arundel,Baltimore,Baltimore City,Carroll,Frederick,
Harford,Howard,Montgomery,Prince Georges,
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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.
Starting February 15, 2021, you can apply for a 2021 Individual health plan for yourself and your family.
Subsidies helped 92% of new members lower their monthly bill in 20201.
1 CMS.gov, Early 2020-2019 Effectuated Enrollment Report
- Plan Network
- Preventive Care Services
- Essential Health Benefits
- Prescription Drug Coverage
We are pleased to offer a STAR plan in the Travis Service Area. This plan is for individuals and families who qualify under Medicaid.
This health plan is available to children (age 18 and younger) and pregnant women who do not qualify for Medicaid and live in the Travis Service Area.
Our STAR Kids plan provides Medicaid services for children and youth age 20 and younger with disabilities.