Blue Medicare Advantage Classic (HMO) 2018

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Blue Medicare Advantage
Classic (HMO)
$0 Monthly Premium

Medicare Advantage plans like BCBSAZ Advantage help fill in the gaps Medicare doesn't cover. You get all of the health and medical benefits of Original Medicare plus additional benefits, like Silver & Fit® and services Medicare doesn't cover — like lower cost-sharing for health care services and coverage for prescription drugs — all in one convenient, easy-to-use plan.

2018 Benefit Chart
Blue Medicare Advantage Classic (HMO)
Plan Premium $0
Out-of-Pocket Maximum $3,400
PCP Visit $0
Specialist Visit $40
Inpatient Hospital Care $250 days 1-7

$1,750 max out-of-pocket
Prescription Drug Coverage Included
Preferred Generics $3

30-day supply
Silver&Fit® Membership Included
Local Service Centers Three Locations


2018 Blue Medicare Advantage Classic Plan Coverage Details


Doctor’s Office Visits:

How much does it cost for a doctor’s office visit?

Under the Classic Plan, you will pay a $0 copay per visit with your primary care doctor and a $40 copay per visit to see a specialty care doctor, such as a heart doctor.

Do I need a referral to see a specialty care doctor?

Yes. You will need to have a referral from your primary care doctor sending you to see a specialty care doctor.
(More information is available in Chapter 3 of your Evidence of Coverage booklet).

Will I ever be billed more than a copay for an office visit?

It will depend on what the doctor does during your office visit. Additional services done at the time of the visit may have separate cost sharing that you would need to pay.
Be sure to talk to your doctor during the visit.

Durable Medical Equipment:

How much does it cost for medical equipment I may need?

Under the Classic Plan, you will pay 20% of the allowed charges. To avoid being charged more, be sure to have the ordering doctor check with BCBSAZ Advantage to see if prior authorization is needed.

Urgently Needed Care:

How much does it cost to be seen at an Urgent Care Facility?

Under the Classic Plan, you will pay a $25 copay per visit.

Do I have to see an Urgent Care doctor that is in-network with BCBSAZ Advantage?

No. Urgently needed care may be received from an in-network or out-of-network doctor when network doctors are not available or difficult to get to.

Is Urgent Needed Care covered while travelling outside the United States?

No. Coverage is limited to the United States and its territories.

Emergency Care:

How much does it cost to be seen in the Emergency Room?

Under the Classic Plan, you will pay a $100 copay at the time of service.

Is there a time when my copay would be waived?

Yes. The copay is waived if you admitted to the hospital through the Emergency Room. Your copay will also be waived if you are admitted to the hospital within one day of being seen in the Emergency Room for the same condition.

Is Emergency Care covered while travelling outside the United States?

No. Coverage is limited to the United States and its territories.

Inpatient Hospital Care:

If I am admitted to the hospital, how much will I have to pay?

Under the Classic Plan, you will pay a $250 copay per day for inpatient days 1 thru 7. If you remain in the hospital another 8 to 364 days, there is no copay due.

Your out of pocket maximum per admission is $1,750.

Copays apply to each inpatient admission.

Will my primary care doctor take care of me in the hospital?

It will depend if your doctor has privileges to see patients in the hospital you were admitted to. A doctor called a hospitalist may be assigned to take care of you when you are admitted to the hospital.

Skilled Nursing Facility (SNF):

If I am admitted to a Skilled Nursing Facility, how much will I have to pay?

Days 1 – 10: $20 copay per day:
Days 11 – 20: $20 copay per day
Days 21 – 100: $165 copay per day

How many days in a Skilled Nursing Facility are covered by the plan?

BCBSAZ Advantage covers up to 100 days each benefit period.

Do I get more benefits if I use all 100 days?

Yes. Your 100 days of benefit will restart when you have been out of a hospital or skilled nursing facility for 60 days in a row or longer.

Do I have to be in the hospital before I can be admitted to a Skilled Nursing Facility?

No.

Outpatient Prescription Drugs:

Do I have to pay a deductible for prescription drugs?

Yes. Under the Classic Plan you have a $195 deductible for drugs in Tiers 3, 4 and 5

What is the Initial Coverage Stage of my drug benefits?

The Initial Coverage Stage is the first of three stages you can enter in a calendar year. You will stay in this stage until the total amount of what you have paid out of pocket and the total amount of what BCBSAZ Advantage has paid for prescription drugs equals $3,750.

What is the Coverage Gap Stage of my drug benefits?

The Coverage Gap Stage is the second of three stages you can enter in a calendar year. You will stay in this stage until the total amount of what you have paid out of pocket for prescription drugs equals $5,000.

What is the Catastrophic Coverage Stage of my drug benefits?

The Catastrophic Coverage Stage is the third and final stage you can enter in a calendar year. If you enter this stage, you will remain in it until the calendar year ends. Your share of the cost for covered drugs will either be coinsurance or copayment, whichever is the larger amount.

Coinsurance will be 5% of the cost of the drug.
$3.35 for a generic drug or a drug that is treated like a generic drug.
$8.35 for all other drugs.

How many cost sharing drug tiers are available?

Under the Classic Plan you will have 5 cost sharing tiers.

Tier 1 – Preferred generic drugs
Tier 2 – Generic drugs
Tier 3 – Preferred brand drugs
Tier 4 – Non-preferred brand drugs
Tier 5 – Specialty drugs

What is a formulary?

A formulary is a list of drugs that are covered by BCBSAZ Advantage. Not all drugs are on this list and there may be certain drug restrictions such as prior authorization, step therapy, and/or quantity limits.