2022 Blue Cross Blue Shield Nebraska MA Access PPO (PPO)

Blue Cross Blue Shield Nebraska MA Access PPO (PPO) H8181-001 is a 2022 Medicare Advantage Plan or Part-C by Blue Cross and Blue Shield of Nebraska available to residents in Nebraska. This plan includes additional prescription drug (Part-D) coverage. The Blue Cross Blue Shield Nebraska MA Access PPO (PPO) has a monthly premium of $26.00 and has an in-network maximum out-of-pocket limit of $4,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,500 out-of-pocket. This can be a extremely nice safety net.

Blue Cross Blue Shield Nebraska MA Access PPO (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 Nebraska works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Blue Cross Blue Shield Nebraska MA Access PPO (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 Nebraska and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Blue Cross and Blue Shield of Nebraska except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 Blue Cross and Blue Shield of Nebraska Medicare Advantage Plan Costs

Blue Cross Blue Shield Nebraska MA Access PPO (PPO) Part-C Premium

Blue Cross and Blue Shield of Nebraska charges a $0.00 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.

H8181-001 Part-D Deductible and Premium

Blue Cross Blue Shield Nebraska MA Access PPO (PPO) has a monthly drug premium of $26.00 and a $100.00 drug deductible. This Blue Cross and Blue Shield of Nebraska plan offers a $26.00 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 $0.00 this Premium covers any enhanced plan benefits offered by Blue Cross and Blue Shield of Nebraska 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 $26.00 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Blue Cross and Blue Shield of Nebraska Gap Coverage

In 2022 once you and your plan provider have spent $4430 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 Nebraska 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 Blue Cross Blue Shield Nebraska MA Access PPO (PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $6.50 for 75% low income subsidy $13.00 for 50% and $19.50 for 25%.

H8181-001 Formulary or Drug Coverage

Blue Cross Blue Shield Nebraska MA Access PPO (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. You can see complete 2022 Blue Cross Blue Shield Nebraska MA Access PPO (PPO) H8181-001 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	$0
Tier 2	NA	$8
Tier 3	NA	$37
Tier 4	NA	$100
Tier 5	NA	31%

*Initial Coverage Phase and 30 day supply

2021 Blue Cross Blue Shield Nebraska MA Access PPO (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	$0 copay
Diagnostic services	$0 copay (Out-of-Network)
Endodontics	$0 copay (Out-of-Network)
Endodontics	$0 copay
Extractions	$0 copay
Extractions	$0 copay (Out-of-Network)
Non-routine services	Not covered
Periodontics	$0 copay
Periodontics	$0 copay (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay
Restorative services	$0 copay (Out-of-Network)
Restorative services	$0 copay

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$20-350 copay (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$100-350 copay
Diagnostic tests and procedures	$20-350 copay (Out-of-Network)
Diagnostic tests and procedures	$20-350 copay
Lab services	$20 copay (Out-of-Network)
Lab services	$0 copay
Outpatient x-rays	$20-350 copay (Out-of-Network)
Outpatient x-rays	$15-350 copay

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Doctor Visits

Primary	$15 copay per visit (Out-of-Network)
Primary	$5 copay per visit
Specialist	$40 copay per visit (Out-of-Network)
Specialist	$30 copay per visit

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$65 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$40 copay (Out-of-Network)
Foot exams and treatment	$30 copay
Routine foot care	Not covered

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Ground Ambulance

$325 copay
$325 copay (Out-of-Network)

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Hearing

Fitting/evaluation	$0 copay (Out-of-Network)
Fitting/evaluation	$0 copay
Hearing aids	$0 copay
Hearing aids	$0 copay (Out-of-Network)
Hearing exam	$5-30 copay
Hearing exam	$0-65 copay (Out-of-Network)

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Inpatient Hospital Coverage

$420 per day for days 1 through 4 $0 per day for days 5 through 90 (Out-of-Network)
$420 per day for days 1 through 4 $0 per day for days 5 through 90

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Medical Equipment/Supplies

Diabetes supplies	0-20% 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
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item (Out-of-Network)

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Medicare Part B Drugs

Chemotherapy	20% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	20% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	$420 per day for days 1 through 4 $0 per day for days 5 through 90 (Out-of-Network)
Inpatient hospital - psychiatric	$420 per day for days 1 through 4 $0 per day for days 5 through 90
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	$40 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit	$40 copay (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit with a psychiatrist	$40 copay (Out-of-Network)

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MOOP

$6,900 In and Out-of-network $4,500 In-network

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Option

Yes, contact plan for further details

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

$350 copay per visit
$350 copay per visit (Out-of-Network)

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Preventive Care

$0 copay
$0 copay (Out-of-Network)

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Preventive Dental

Cleaning	$0 copay
Cleaning	$0 copay (Out-of-Network)
Dental x-ray(s)	$0 copay
Dental x-ray(s)	$0 copay (Out-of-Network)
Fluoride treatment	Not covered
Oral exam	$0 copay (Out-of-Network)
Oral exam	$0 copay

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Rehabilitation Services

Occupational therapy visit	$40 copay
Occupational therapy visit	$40 copay (Out-of-Network)
Physical therapy and speech and language therapy visit	$40 copay (Out-of-Network)
Physical therapy and speech and language therapy visit	$40 copay

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Skilled Nursing Facility

$0 per day for days 1 through 20 $179 per day for days 21 through 46 $0 per day for days 47 through 100
$0 per day for days 1 through 20 $179 per day for days 21 through 59 $0 per day for days 60 through 100 (Out-of-Network)

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Transportation

Not covered

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Vision

Contact lenses	50% coinsurance (Out-of-Network)
Contact lenses	$0 copay
Eyeglass frames	50% coinsurance (Out-of-Network)
Eyeglass frames	$0 copay
Eyeglass lenses	50% coinsurance (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglasses (frames and lenses)	Not covered
Other	Not covered
Routine eye exam	$0 copay
Routine eye exam	50% coinsurance (Out-of-Network)
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Blue Cross Blue Shield Nebraska MA Access PPO (PPO) H8181

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Blue Cross Blue Shield Nebraska MA Access PPO (PPO) Plans Performance

Health Plan Customer Service Rating for Blue Cross Blue Shield Nebraska MA Access PPO (PPO)

Blue Cross Blue Shield Nebraska MA Access PPO (PPO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for Blue Cross Blue Shield Nebraska MA Access PPO (PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, 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 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.