2022 Blue Medicare Medical Only (HMO)
Blue Medicare Medical Only (HMO) H3449-012 is a 2022 Medicare Advantage Plan or Part-C by Blue Cross and Blue Shield of North Carolina available to residents in North Carolina. This plan does not provide additional prescription drug (Part-D) coverage. The Blue Medicare Medical Only (HMO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $3,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay
$3,900 out-of-pocket. This can be a extremely nice safety net.
Blue Medicare Medical Only (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.
Blue Cross and Blue Shield of North Carolina works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Blue Medicare Medical Only (HMO) 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 North Carolina 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 North Carolina 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 North Carolina Medicare Advantage Plan Costs
Name: | Blue Medicare Medical Only (HMO) |
Plan ID: | H3449-012 |
Provider: | Blue Cross and Blue Shield of North Carolina |
Year: | 2022 |
Type: | Local HMO * |
Monthly Premium C+D: | $0 |
Part C Premium: | |
MOOP: | $3,900 |
Similar Plan: | H3449-023 |
New Plan: | 2023 H3449-023 |
2021 Blue Medicare Medical Only (HMO) Summary of Benefits
*This will be updated with 2022 data when available.
Additional Benefits
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
Diagnostic Tests and Procedures
Diagnostic radiology services (e.g., MRI) |
$0-300 copay or 20% coinsurance |
Diagnostic tests and procedures |
$0-25 copay |
Lab services |
$0-5 copay |
Outpatient x-rays |
$0-15 copay |
Doctor Visits
Primary |
$20 copay per visit |
Specialist |
$40 copay per visit |
Emergency care/Urgent Care
Emergency |
$90 copay per visit (always covered) |
Urgent care |
$65 copay per visit (always covered) |
Foot Care (podiatry services)
Foot exams and treatment |
$40 copay |
Routine foot care |
Not covered |
Ground Ambulance
Hearing
Fitting/evaluation |
$0 copay |
Hearing aids |
$699-999 copay |
Hearing exam |
$40 copay |
Inpatient Hospital Coverage
$335 per day for days 1 through 6 $0 per day for days 7 through 90 $0 per day for days 91 and beyond |
|
|
Medical Equipment/Supplies
Diabetes supplies |
$0 copay per item |
Durable medical equipment (e.g., wheelchairs, oxygen) |
20% coinsurance per item |
Prosthetics (e.g., braces, artificial limbs) |
20% coinsurance per item |
Medicare Part B Drugs
Chemotherapy |
20% coinsurance |
Other Part B drugs |
20% coinsurance |
Mental Health Services
Inpatient hospital - psychiatric |
$300 per day for days 1 through 6 $0 per day for days 7 through 90 |
Outpatient group therapy visit |
$40 copay |
Outpatient group therapy visit with a psychiatrist |
$40 copay |
Outpatient individual therapy visit |
$40 copay |
Outpatient individual therapy visit with a psychiatrist |
$40 copay |
MOOP
Option
Optional supplemental benefits
Outpatient Hospital Coverage
Preventive Care
Preventive Dental
Cleaning |
$0 copay |
Dental x-ray(s) |
$0 copay |
Fluoride treatment |
$0 copay |
Oral exam |
$0 copay |
Rehabilitation Services
Occupational therapy visit |
$40 copay |
Physical therapy and speech and language therapy visit |
$40 copay |
Skilled Nursing Facility
$0 per day for days 1 through 20 $184 per day for days 21 through 60 $0 per day for days 61 through 100 |
|
|
Transportation
Vision
Contact lenses |
$0 copay |
Eyeglass frames |
$0 copay |
Eyeglass lenses |
$0 copay |
Eyeglasses (frames and lenses) |
$0 copay |
Other |
Not covered |
Routine eye exam |
$25 copay |
Upgrades |
$0 copay |
Wellness Programs (e.g. fitness nursing hotline)
CMS Star Ratings for Blue Medicare Medical Only (HMO) H3449
2021 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 | | |
Monitoring Physical Activity | | |
Managing Chronic And Long Term Care for Older Adults
Total Rating | | |
SNP Care Management | | |
Medication Review | | |
Functional Status Assessment | | |
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 | | |
Getting Appointments | | |
Customer Service | | |
Health Care Quality | | |
Rating of Health Plan | | |
Care Coordination | | |
Member Complaints and Changes in Blue Medicare Medical Only (HMO) Plans Performance
Total Rating | | |
Complaints about Health Plan | | |
Members Leaving the Plan | | |
Health Plan Quality Improvement | | |
Health Plan Customer Service Rating for Blue Medicare Medical Only (HMO)
Total Customer Service Rating | | |
Timely Decisions About Appeals | | |
Reviewing Appeals Decisions | | |
Call Center, TTY, Foreign Language | | |
Blue Medicare Medical Only (HMO) Drug Plan Customer Service Ratings
Total Rating | | |
Call Center, TTY, Foreign Language | | |
Ratings For Member Complaints and Changes in the Drug Plans Performance
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?
Click Here |
Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST
Coverage Area for Blue Medicare Medical Only (HMO)
(Click county to compare all available Advantage plans)
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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.