Blue Cross Blue Shield of Kansas City Medicare Advantage
medicare plans for
Know Your Medicare Advantage Options
The first step in your Medicare journey is knowing your options. That's why we created an easy-to-use tool that matches you with the plans available in your area.
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Know Your Medicare Advantage Options
Blue Medicare Advantage Essential (PPO)
A $0 PPO, $0 medical and prescription drug deductible and a low maximum out-of-pocket of $3,425 for in-network and out-of-network costs. This plan also includes valuable extra benefits, including Blue Benefit Bucks to use on health related services.
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Simply Blue (PPO)
A PPO plan that offers flexibility to access providers that are in-network and out-of-network as long as they accept Medicare, as well as Blue Benefit Bucks for use on health-related services all at a $0 monthly premium.
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Simply Blue Advantage (PPO)
A $0 PPO and $0 medical and prescription drug deductible. This plan offers a $75 per month Part B giveback.
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Blue Medicare Advantage Flex (no Part D) (PPO)
Take advantage of all the benefits of a Blue Medicare Advantage plan even if you don't need Part D Prescription Drug Coverage at a $0 monthly premium.
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Blue Secure (HMO)
An HMO plan with $0 monthly premium, coverage in the gap in Tier 1 and Tier 2, $0 deductible and low in-network out-of-pocket maximum of $3,650. Blue Secure also include extra benefits and Blue Benefit Bucks giving you the power to decided where and how you'd like to use you benefits.
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Blue Medicare Advantage Spira Care (HMO)
An HMO plan coordinated through Spira Care that takes the worry out about how and when to get care all at a $0 monthly premium and $3,000 out-of-pocket maximum.
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Supplemental Benefits
Blue Medicare Advantage plans do more than help pay for medical costs. You get valuable extra benefits to help you feel better, live better, and save money – every day.
Blue Benefit Bucks – New for 2022
It works like a debit card so it's simple to use. It's loaded with the benefits from the plan you choose and you have the power to spend it on health related items.
Dental
The health of your mouth, teeth and gums is closely related to your overall health. Enjoy a brighter smile with dental benefits in most Blue Medicare Advantage plans.
Vision
Most Blue Medicare Advantage plans offer vision coverage including eyewear, contact lenses and prescription sunglasses. They may also include vision benefits such as coverage for routine eye exams.
Hearing
Your hearing is important to enjoying your retirement activities, and to your overall health. Most of our plans offer the option for hearing exams and, if you need it, hearing aid fitting and purchase up to the plan's limit.
Transportation
Getting to your appointments is important to maintaining your health. Many of our plans offer the option to use the Blue Benefit Bucks card to schedule and pay for transportation or to use a one-way trip allowance.
Over-the-Counter Allowance
With Blue Medicare Advantage plans, you get a generous over-the-counter benefit allowance loaded on our Blue Benefit Bucks pre-paid debit card for your convenience.
SilverSneakers® Fitness
Meet your friends at the gym and stay fit with a SilverSneakers® membership at no extra cost.
Companion & Caregiver Support
If you need help with household chores, technical guidance or other daily tasks, your Blue Medicare Advantage plan can help.
Mindful By Blue KC
Mindful by Blue KC provides a set of behavioral health resources to help you address stress, depression, anxiety, substance use, and more. You also have 24/7 access to Mindful Advocates.
Virtual Care
Virtual Care allows you to get the medical care you need, when you need it, from the safety and convenience of your home, right on your smartphone, tablet or computer.
Diabetes Management
The program is offered at no cost to select members with Diabetes and coverage through the Blue Medicare Advantage plan.
Personal Emergency Response
We'll provide you with the devices and systems to protect your health and safety so you feel safe at home and everywhere you go with this new benefit from Best Buy Health.
Benefits vary by plan.
Benefits Comparison Chart
Blue Medicare Advantage Plans At-A-Glance
| You must continue to pay Part B premium | Essential(PPO) | Simply Blue(PPO) | Simply Blue Advantage(PPO) | Flex(no Part D)(PPO) | Blue Secure(HMO) | Spira Care(HMO) |
|---|---|---|---|---|---|---|
| Total Premium | ||||||
| Total Premium | $0 | $0 | $0 | $0 | $0 | $0 |
| Blue National Network | ||||||
| Blue National Network | Covered | Covered | Covered | Covered | N/A | N/A |
| Plan Deductible | ||||||
| Plan Deductible | $0 | $0 | $0 | $0 | $0 | $0 |
| Maximum Out of Pocket (MOOP) | ||||||
| Maximum Out of Pocket (MOOP) | $3,425 | $4,800 | $7,250 | $4,000 | $3,650 | $3,000 |
Inpatient Services | ||||||
| Inpatient Hospital - Acute | ||||||
| Inpatient Hospital - Acute | In-Network$325/day, Days 1-5 Out-of-Network45% per stay | In-Network$300/day, Days 1-5 Out-of-Network$300/day, Days 1-5 | In-Network$500/day, Days 1-4 Out-of-Network$500/day, Days 1-4 | In-Network$285/day, Days 1-6 Out-of-Network$285/day, Days 1-6 | In-Network$285/day, Days 1-5 | In-Network$300/day, Days 1-5 |
| Skilled Nursing Facility | ||||||
| Skilled Nursing Facility | In-Network$20/day, Days 1-20 Out-of-Network45% Days 1-100 | In-Network$0, Days 1-20 Out-of-Network$0, Days 1-20 | In-Network$0, Days 1-20 Out-of-Network$0, Days 1-20 | In-Network$0, Days 1-20 Out-of-Network$0, Days 1-20 | In-Network$0, Days 1-20 | In-Network$20/day, Days 1-20 |
Emergency Care/Urgent Care | ||||||
| Emergency Care (Worldwide) | ||||||
| Emergency Care (Worldwide) | In-Network$120 Out-of-Network$120 | In-Network$90 Out-of-Network$90 | In-Network$90 Out-of-Network$90 | In-Network$90 Out-of-Network$90 | In-Network$90 | In-Network$120 |
| Urgently Needed Care (Worldwide) | ||||||
| Urgently Needed Care (Worldwide) | In-Network$50 Out-of-Network$50 | In-Network$50 Out-of-Network$50 | In-Network$50 Out-of-Network$50 | In-Network$50 Out-of-Network$50 | In-Network$50 | In-Network$50 |
| Ambulance Services (Worldwide) | ||||||
| Ambulance Services (Worldwide) | In-Network$300 Out-of-Network$300 | In-Network$300 Out-of-Network$300 | In-Network$300 Out-of-Network$300 | In-Network$285 Out-of-Network$285 | In-Network$285 | In-Network$300 |
Professional Services | ||||||
| PCP Visit | ||||||
| PCP Visit | In-Network$0 Out-of-Network$25 | In-Network$0 Out-of-Network$0 | In-Network$0 Out-of-Network$0 | In-Network$0 Out-of-Network$0 | In-Network$0 | In-Network$0 |
| Specialist Visit | ||||||
| Specialist Visit | In-Network$25 Out-of-Network$50 | In-Network$35 Out-of-Network$35 | In-Network$30 Out-of-Network$30 | In-Network$20 Out-of-Network$20 | In-Network$40 | In-Network$30 |
| Telehealth | ||||||
| Telehealth | In-Network$0 Out-of-NetworkN/A | In-Network$0 Out-of-NetworkN/A | In-Network$0 Out-of-NetworkN/A | In-Network$0 Out-of-NetworkN/A | In-Network$0 | In-Network$0 |
Diagnostic Testing Services | ||||||
| Diagnostic Procedures/Tests | ||||||
| Diagnostic Procedures/Tests | In-Network$0 Out-of-Network45% | In-Network$0 Out-of-Network$0 | In-Network$0 Out-of-Network$0 | In-Network$0 Out-of-Network$0 | In-Network$0 | In-Network$0 |
| Lab Services | ||||||
| Lab Services | In-Network$0 Out-of-Network45% | In-Network$0 Out-of-Network$0 | In-Network$0 Out-of-Network$0 | In-Network$0 Out-of-Network$0 | In-Network$0 | In-Network$0 |
| X-Ray Services | ||||||
| X-Ray Services | In-Network$0 Out-of-Network45% | In-Network$0 Out-of-Network$0 | In-Network$0 Out-of-Network$0 | In-Network$0 Out-of-Network$0 | In-Network$0 | In-Network$0 |
| MRI/CT at physicians office or free standing | ||||||
| MRI/CT at physicians office or free standing | In-Network$100 Out-of-Network45% | In-Network$100 Out-of-Network$100 | In-Network$150 Out-of-Network$150 | In-Network$185 Out-of-Network$185 | In-Network$100 | In-Network$200 |
| MRI/CT at other facility | ||||||
| MRI/CT at other facility | In-Network$250 Out-of-Network45% | In-Network$250 Out-of-Network$250 | In-Network$300 Out-of-Network$300 | In-Network$285 Out-of-Network$285 | In-Network$285 | In-Network$300 |
Outpatient Services | ||||||
| Observation | ||||||
| Observation | In-Network$325 Out-of-Network45% | In-Network$300 Out-of-Network$300 | In-Network$500 Out-of-Network$500 | In-Network$285 Out-of-Network$285 | In-Network$285 | In-Network$300 |
| Outpatient Hospital & ASC (Minor surgical; other services) | ||||||
| Outpatient Hospital & ASC (Minor surgical; other services) | In-Network20% Out-of-Network45% | In-Network20% Out-of-Network20% | In-Network20% Out-of-Network20% | In-Network20% Out-of-Network20% | In-Network20% | In-Network20% |
| Surgery (Ambulatory Surgical Center) | ||||||
| Surgery (Ambulatory Surgical Center) | In-Network$250 Out-of-Network45% | In-Network$250 Out-of-Network$250 | In-Network$300 Out-of-Network$300 | In-Network$285 Out-of-Network$285 | In-Network$285 | In-Network$300 |
| Surgery (Outpatient Hospital) | ||||||
| Surgery (Outpatient Hospital) | In-Network$325 Out-of-Network45% | In-Network$300 Out-of-Network$300 | In-Network$500 Out-of-Network$500 | In-Network$285 Out-of-Network$285 | In-Network$285 | In-Network$300 |
Supplemental Services | ||||||
| Dental | ||||||
| Dental | In-Network$0 copay, 2 exams/cleaning, 1 X-ray/fluoride; 50% coinsurance for comprehensive Out-of-Network50% coinsurance preventive services; 50% coinsurance for comprehensive $1,000 benefit max for preventive and comprehensive In- and Out-of-Network combined | $1,000 Blue Benefit Bucks allowance for dental, hearing services, transportation and eyewear combined | Not covered | $1,000 Blue Benefit Bucks allowance for dental, hearing services, transportation and eyewear combined | In-Network100% coverage for preventive $1,000 benefit maximum | In-Network100% coverage for preventive $1,000 benefit maximum |
| Eyewear | ||||||
| Eyewear | $500 Blue Benefit Bucks for transportation and eyewear combined | $1,000 Blue Benefit Bucks allowance for dental, hearing services, transportation and eyewear combined | Not covered | $1,000 Blue Benefit Bucks allowance for dental, hearing services, transportation and eyewear combined | $500 allowance for transportation and eyewear combined | $300 per year |
| Transportation | ||||||
| Transportation | $500 Blue Benefit Bucks for transportation and eyewear combined | $1,000 Blue Benefit Bucks allowance for dental, hearing services, transportation and eyewear combined | Not covered | $1,000 Blue Benefit Bucks allowance for dental, hearing services, transportation and eyewear combined | $500 allowance for transportation and eyewear combined | 20 one-way trips |
| Hearing and Hearing Aids | ||||||
| Hearing and Hearing Aids | $0 hearing exam; up to $500 per ear per year for hearing aids | $1,000 Blue Benefit Bucks allowance for dental, hearing services, transportation and eyewear combined | Not covered | $1,000 Blue Benefit Bucks allowance for dental, hearing services, transportation and eyewear combined | $0 hearing exam; up to $500 per ear per year for hearing aids | $0 hearing exam; up to $500 per ear per year for hearing aids |
| Over-the-counter allowance | ||||||
| Over-the-counter allowance | $100 per quarter | $500 per year | Not covered | $500 per year | $100 per quarter | $100 per quarter |
Essential (PPO)
Blue National Network
Covered
Maximum Out of Pocket (MOOP)
$3,425
Inpatient Hospital - Acute
In-Network
$325/day, Days 1-5; $0, Days 6-90*
Out-of-Network
45% per stay
Skilled Nursing Facility
In-Network
$20/day, Days 1-20; $188/day, Days 21-100
Out-of-Network
45%, Days 1-100
Emergency Care/Urgent Care
Emergency Care (Worldwide)
In-Network
$120
Out-of-Network
$120
Urgently Needed Care (Worldwide)
In-Network
$50
Out-of-Network
$50
Ambulance Services (Worldwide)
In-Network
$300
Out-of-Network
$300
PCP Visit
In-Network
$0
Out-of-Network
$25
Specialist Visits
In-Network
$25
Out-of-Network
$50
Telehealth
In-Network
$0
Out-of-Network
N/A
Diagnostic Testing Services
Other Diagnostic Procedures/Tests
In-Network
$0
Out-of-Network
45%
Lab Services
In-Network
$0
Out-of-Network
45%
X-Ray Services
In-Network
$0
Out-of-Network
45%
MRI/CT at physicians office or free standing
In-Network
$100
Out-of-Network
45%
MRI/CT at other facility
In-Network
$250
Out-of-Network
45%
Observation
In-Network
$325
Out-of-Network
45%
Outpatient Hospital & ASC (Minor surgical; other services)
In-Network
20%
Out-of-Network
45%
Surgery (Ambulatory Surgical Center)
In-Network
$250
Out-of-Network
45%
Surgery (Outpatient Hospital)
In-Network
$325
Out-of-Network
45%
Dental
In-Network
$0 copay, 2 exams/cleaning, 1 X-ray/fluoride; 50% coinsurance for comprehensive
Out-of-Network
50% coinsurance preventive services; 50% coinsurance for comprehensive
$1,000 benefit max for preventive and comprehensive In- and Out-of-Network combined
Eyewear
$500 Blue Benefit Bucks for transportation and eyewear combined
Transportation
$500 Blue Benefit Bucks for transportation and eyewear combined
Hearing and Hearing Aids
$0 hearing exam; up to $500 per ear per year for hearing aids
Over-the-counter allowance
$100 per quarter
Simply Blue (PPO)
Blue National Network
Covered
Maximum Out of Pocket (MOOP)
$4,800
Inpatient Hospital - Acute
In-Network
$300/day, Days 1-5; $0, Days 6-90*
Out-of-Network
$300/day, Days 1-5; $0, Days 6-90
Skilled Nursing Facility
In-Network
$0, Days 1-20; $188/day, Days 21-100
Out-of-Network
$0, Days 1-20; $188/day, Days 21-100
Emergency Care/Urgent Care
Emergency Care (Worldwide)
In-Network
$90
Out-of-Network
$90
Urgently Needed Care (Worldwide)
In-Network
$50
Out-of-Network
$50
Ambulance Services (Worldwide)
In-Network
$300
Out-of-Network
$300
PCP Visit
In-Network
$0
Out-of-Network
$0
Specialist Visits
In-Network
$35
Out-of-Network
$35
Telehealth
In-Network
$0
Out-of-Network
$0
Diagnostic Testing Services
Diagnostic Procedures/Tests
In-Network
$0
Out-of-Network
$0
Lab Services
In-Network
$0
Out-of-Network
$0
X-Ray Services
In-Network
$0
Out-of-Network
$0
MRI/CT at physicians office or free standing
In-Network
$100
Out-of-Network
$100
MRI/CT at other facility
In-Network
$250
Out-of-Network
$250
Observation
In-Network
$300
Out-of-Network
$300
Outpatient Hospital & ASC (Minor surgical; other services)
In-Network
20%
Out-of-Network
20%
Surgery (Ambulatory Surgical Center)
In-Network
$250
Out-of-Network
$250
Surgery (Outpatient Hospital)
In-Network
$300
Out-of-Network
$300
Dental
$1,000 Blue Benefit Bucks allowance for dental, hearing services, transportation and eyewear combined
Eyewear
$1,000 Blue Benefit Bucks allowance for dental, hearing services, transportation and eyewear combined
Transportation
$1,000 Blue Benefit Bucks allowance for dental, hearing services, transportation and eyewear combined
Hearing and Hearing Aids
$1,000 Blue Benefit Bucks allowance for dental, hearing services, transportation and eyewear combined
Over-the-counter allowance
$500 per year
Simply Blue Advantage (PPO)
Blue National Network
Covered
Maximum Out of Pocket (MOOP)
$7,250
Inpatient Hospital - Acute
In-Network
$500/day, Days 1-4; $0, Days 5-90*
Out-of-Network
$500/day, Days 1-4; $0, Days 5-90
Skilled Nursing Facility
In-Network
$0, Days 1-20; $188/day, Days 21-100
Out-of-Network
$0, Days 1-20; $188/day, Days 21-100
Emergency Care/Urgent Care
Emergency Care (Worldwide)
In-Network
$90
Out-of-Network
$90
Urgently Needed Care (Worldwide)
In-Network
$50
Out-of-Network
$50
Ambulance Services (Worldwide)
In-Network
$300
Out-of-Network
$300
PCP Visit
In-Network
$0
Out-of-Network
$0
Specialist Visits
In-Network
$30
Out-of-Network
$30
Telehealth
In-Network
$0
Out-of-Network
$0
Diagnostic Testing Services
Diagnostic Procedures/Tests
In-Network
$0
Out-of-Network
$0
Lab Services
In-Network
$0
Out-of-Network
$0
X-Ray Services
In-Network
$0
Out-of-Network
$0
MRI/CT at physicians office or free standing
In-Network
$150
Out-of-Network
$150
MRI/CT at other facility
In-Network
$300
Out-of-Network
$300
Observation
In-Network
$500
Out-of-Network
$500
Outpatient Hospital & ASC (Minor surgical; other services)
In-Network
20%
Out-of-Network
20%
Surgery (Ambulatory Surgical Center)
In-Network
$300
Out-of-Network
$300
Surgery (Outpatient Hospital)
In-Network
$500
Out-of-Network
$500
Transportation
Not covered
Hearing and Hearing Aids
Not covered
Over-the-counter allowance
Not covered
Flex (no Part D) (PPO)
Blue National Network
Covered
Maximum Out of Pocket (MOOP)
$4,000
Inpatient Hospital - Acute
In-Network
$285/day, Days 1-6; $0, Days 7-90*
Out-of-Network
$285/day, Days 1-6; $0, Days 7-90
Skilled Nursing Facility
In-Network
$0, Days 1-20; $184/day, Days 21-100
Out-of-Network
$0, Days 1-20; $184/day, Days 21-100
Emergency Care/Urgent Care
Emergency Care (Worldwide)
In-Network
$90
Out-of-Network
$90
Urgently Needed Care (Worldwide)
In-Network
$50
Out-of-Network
$50
Ambulance Services (Worldwide)
In-Network
$285
Out-of-Network
$285
PCP Visit
In-Network
$0
Out-of-Network
$0
Specialist Visits
In-Network
$20
Out-of-Network
$20
Telehealth
In-Network
$0
Out-of-Network
$0
Diagnostic Testing Services
Diagnostic Procedures/Tests
In-Network
$0
Out-of-Network
$0
Lab Services
In-Network
$0
Out-of-Network
$0
X-Ray Services
In-Network
$0
Out-of-Network
$0
MRI/CT at physicians office or free standing
In-Network
$185
Out-of-Network
$185
MRI/CT at other facility
In-Network
$285
Out-of-Network
$285
Observation
In-Network
$285
Out-of-Network
$285
Outpatient Hospital & ASC (Minor surgical; other services)
In-Network
20%
Out-of-Network
20%
Surgery (Ambulatory Surgical Center)
In-Network
$285
Out-of-Network
$285
Surgery (Outpatient Hospital)
In-Network
$285
Out-of-Network
$285
Dental
$1,000 Blue Benefit Bucks allowance for dental, hearing services, transportation and eyewear combined
Eyewear
$1,000 Blue Benefit Bucks allowance for dental, hearing services, transportation and eyewear combined
Transportation
$1,000 Blue Benefit Bucks allowance for dental, hearing services, transportation and eyewear combined
Hearing and Hearing Aids
$1,000 Blue Benefit Bucks allowance for dental, hearing services, transportation and eyewear combined
Over-the-counter allowance
$500 per year
Blue Secure (HMO)
Blue National Network
N/A
Maximum Out of Pocket (MOOP)
$3,650
Inpatient Hospital - Acute
In-Network
$285/day, Days 1-5; $0, Days 6-90*
Skilled Nursing Facility
In-Network
$0, Days 1-20; $184/day, Days 21-100
Emergency Care/Urgent Care
Emergency Care (Worldwide)
Urgently Needed Care (Worldwide)
Ambulance Services (Worldwide)
Diagnostic Testing Services
Other Diagnostic Procedures/Tests
MRI/CT at physicians office or free standing
Outpatient Hospital & ASC (Minor surgical; other services)
Surgery (Ambulatory Surgical Center)
Surgery (Outpatient Hospital)
Dental
In-Network
100% coverage for preventive; 50% coverage for comprehensive
$1,000 benefit maximum
Eyewear
$500 allowance for transportation and eyewear combined
Transportation
$500 allowance for transportation and eyewear combined
Hearing and Hearing Aids
$0 hearing exam; up to $500 per ear per year for hearing aids
Over-the-counter allowance
$100 per quarter
Spira Care (HMO)
Blue National Network
N/A
Maximum Out of Pocket (MOOP)
$3,000
Inpatient Hospital - Acute
In-Network
$300/day, Days 1-5; $0, Days 6-90*
Skilled Nursing Facility
In-Network
$20/day, Days 1-20
$188/day, Days 21-100
Emergency Care/Urgent Care
Emergency Care (Worldwide)
Urgently Needed Care (Worldwide)
Ambulance Services (Worldwide)
Diagnostic Testing Services
Diagnostic Procedures/Tests
MRI/CT at physicians office or free standing
Outpatient Hospital & ASC (Minor surgical; other services)
Surgery (Ambulatory Surgical Center)
Surgery (Outpatient Hospital)
Dental
In-Network
100% coverage for preventive; 50% coverage for comprehensive
$1,000 benefit maximum
Transportation
20 one-way trips
Hearing and Hearing Aids
$0 hearing exam; up to $500 per ear per year for hearing aids
Over-the-counter allowance
$100 per quarter
*After 90 days, our plan covers an unlimited number of additional days for an inpatient hospital stay at $0 copay.
Benefits Comparison Chart
Blue Medicare Advantage Prescription Drug Benefits
We offer a 100-day mail order and retail drug benefit with a $0 copay for all Tier 1 and Tier 2 prescription drugs.
Essential(PPO) | Simply Blue(PPO) | Simply Blue Advantage(PPO) | Flex (no Part D)(PPO) | Blue Secure(HMO) | Spira Care(HMO) | |
|---|---|---|---|---|---|---|
| Annual Deductible | ||||||
| Annual Deductible | $0 | $0 | $0 | Not covered | $0 | $0 |
| Preferred Generics (Tier 1) | ||||||
| Preferred Generics (Tier 1) | 30-day Supply$0 copay 100-day Supply$0 copay | 30-day Supply$0 copay 100-day Supply$0 copay | 30-day Supply$0 copay 100-day Supply$0 copay | Not covered | 30-day Supply$0 copay 100-day Supply$0 copay | 30-day Supply$0 copay 100-day Supply$0 copay |
| Generics (Tier 2) | ||||||
| Generics (Tier 2) | 30-day Supply$10 copay 100-day Supply$0 copay | 30-day Supply$10 copay 100-day Supply$0 copay | 30-day Supply$10 copay 100-day Supply$0 copay | Not covered | 30-day Supply$5 copay 100-day Supply$0 copay | 30-day Supply$5 copay 100-day Supply$0 copay |
| Preferred Brands (Tier 3) | ||||||
| Preferred Brands (Tier 3) | 30-day Supply$47 copay 90-day Supply$141 copay | 30-day Supply$47 copay 90-day Supply$141 copay | 30-day Supply$47 copay 90-day Supply$141 copay | Not covered | 30-day Supply$47 copay 90-day Supply$141 copay | 30-day Supply$47 copay 90-day Supply$141 copay |
| Non-Preferred Drugs (Tier 4) | ||||||
| Non-Preferred Drugs (Tier 4) | 30-day Supply$100 copay 90-day Supply$300 copay | 30-day Supply$100 copay 90-day Supply$300 copay | 30-day Supply$100 copay 90-day Supply$300 copay | Not covered | 30-day Supply$100 copay 90-day Supply$300 copay | 30-day Supply$100 copay 90-day Supply$300 copay |
| Specialty Drugs (Tier 5) | ||||||
| Specialty Drugs (Tier 5) | 30-day Supply33% 90-day SupplyN/A | 30-day Supply33% 90-day SupplyN/A | 30-day Supply33% 90-day SupplyN/A | Not covered | 30-day Supply33% 90-day SupplyN/A | 30-day Supply33% 90-day SupplyN/A |
| Gap Coverage | ||||||
| Gap Coverage | Original Medicare Standard: 25% for all Tiers | Original Medicare Standard: 25% for all Tiers | Original Medicare Standard: 25% for all Tiers | Not covered | Tier 1 and Tier 2 | Tier 1 and Tier 2 |
| $35 Insulin Program | ||||||
| $35 Insulin Program | Yes | Yes | Yes | Not covered | Yes | Yes |
Essential (PPO)
Preferred Generics (Tier 1)
30-day Supply
$3 copay
90-day Supply
$0 copay
Generics (Tier 2)
30-day Supply
$10 copay
90-day Supply
$0 copay
Preferred Brands (Tier 3)
30-day Supply
$47 copay
90-day Supply
$141 copay
Non-Preferred Drugs (Tier 4)
30-day Supply
$100 copay
90-day Supply
$300 copay
Specialty Drugs (Tier 5)
30-day Supply
33%
90-day Supply
N/A
Gap Coverage
Original Medicare Standard: 25% for all Tiers
Access (PPO)
Preferred Generics (Tier 1)
30-day Supply
$0 copay
90-day Supply
$0 copay
Generics (Tier 2)
30-day Supply
$5 copay
90-day Supply
$0 copay
Preferred Brands (Tier 3)
30-day Supply
$47 copay
90-day Supply
$141 copay
Non-Preferred Drugs (Tier 4)
30-day Supply
$100 copay
90-day Supply
$300 copay
Specialty Drugs (Tier 5)
30-day Supply
33%
90-day Supply
N/A
Gap Coverage
T1 & T2 with same copay amounts & Tiers 3, 4 & 5 at 25%
Complete (HMO)
Preferred Generics (Tier 1)
30-day Supply
$3 copay
90-day Supply
$0 copay
Generics (Tier 2)
30-day Supply
$10 copay
90-day Supply
$0 copay
Preferred Brands (Tier 3)
30-day Supply
$47 copay
90-day Supply
$141 copay
Non-Preferred Drugs (Tier 4)
30-day Supply
$100 copay
90-day Supply
$300 copay
Specialty Drugs (Tier 5)
30-day Supply
33%
90-day Supply
N/A
Gap Coverage
Original Medicare Standard: 25% for all Tiers
Plus (HMO)
Preferred Generics (Tier 1)
30-day Supply
$0 copay
90-day Supply
$0 copay
Generics (Tier 2)
30-day Supply
$5 copay
90-day Supply
$0 copay
Preferred Brands (Tier 3)
30-day Supply
$47 copay
90-day Supply
$141 copay
Non-Preferred Drugs (Tier 4)
30-day Supply
$100 copay
90-day Supply
$300 copay
Specialty Drugs (Tier 5)
30-day Supply
33%
90-day Supply
N/A
Gap Coverage
T1 & T2 with same copay amounts & Tiers 3, 4 & 5 at 25%
Spira Care (HMO)
Preferred Generics (Tier 1)
30-day Supply
$0 copay
90-day Supply
$0 copay
Generics (Tier 2)
30-day Supply
$5 copay
90-day Supply
$0 copay
Preferred Brands (Tier 3)
30-day Supply
$47 copay
90-day Supply
$141 copay
Non-Preferred Drugs (Tier 4)
30-day Supply
$100 copay
90-day Supply
$300 copay
Specialty Drugs (Tier 5)
30-day Supply
33%
90-day Supply
N/A
Gap Coverage
T1 & T2 with same copay amounts & Tiers 3, 4 & 5 at 25%
This information is not a complete description of benefits.
This information is not a complete description of benefits. Contact the plan for more information. You may also see our Summary of Benefits for more information. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. The Formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary. For HMO plan, members must use plan providers except in emergency or urgent care situations. If a member obtains routine care from an out-of-network provider without prior approval from Blue KC, neither Medicare nor Blue KC will be responsible for the costs. For PPO plan members, Blue Medicare Advantage (PPO) members are encouraged to use in-network plan providers. Out-of-network/non-contracted providers are under no obligation to treat members, except in emergency situations. For a decision about whether Blue KC will cover an out-of-network service, we encourage you or your provider to ask Blue KC for a pre-service organization determination before the service is received. Please call Blue Medicare Advantage Customer Service or refer to the Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Limitations, copayments, and restrictions may apply. Part D drug expenses are not covered under the maximum out-of-pocket limit.
Anyone with Medicare Parts A and B living in the Missouri counties of Andrew, Bates, Buchanan, Cass, Clay, Clinton, Jackson, Johnson, Lafayette, Platte and Ray, or in the Kansas counties of Johnson and Wyandotte may apply to join Blue Medicare Advantage. Please note that enrollment may be limited to specific times of the year.
Medicare Coverage you can count on.
We've put our years of local knowledge to work building affordable, high-quality Medicare plans that meet the needs of our community across 32 counties.
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Blue Medicare Advantage & Medicare Supplement
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Medicare Supplement Only
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Kansas City
Key Enrollment Dates
Initial Coverage Enrollment Period (IEP)
For those turning 65 (and therefore becoming eligible for Medicare for the first time), you may enroll from three months before to three months after you become eligible for Medicare.
Special Enrollment Period (SEP)
You may be able to enroll at a different time of the year. To learn more about special enrollment periods, visit http://www.medicare.gov.
Annual Enrollment Period (AEP)
From October 15 to December 7, you can switch to, drop, or join a different Medicare plan.
Open Enrollment Period
During Open Enrollment, Medicare beneficiaries are allowed to make "Like plan" changes from January 1 to March 31. Medicare beneficiaries can disenroll from their current plan and select a new plan with their existing carrier of competitor.
Source: https://www.medicarebluekc.com/medicare-plans
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