2022 BlueMedicare Preferred (PFFS)

BlueMedicare Preferred (PFFS) H4213-017 is a 2022 Medicare Advantage Plan or Part-C by Arkansas Blue Medicare available to residents in Arkansas. This plan includes additional prescription drug (Part-D) coverage. The BlueMedicare Preferred (PFFS) has a monthly premium of $60.00 and has an in-network maximum out-of-pocket limit of $- (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $- out-of-pocket. This can be a extremely nice safety net.

BlueMedicare Preferred (PFFS) is a PFFS. A Private Fee-For-Service (PFFS) plan is a Medicare Advantage (MA) health plan offered by a contract with the Centers for Medicare & Medicaid Services (CMS) to provide you with benefits. Arkansas Blue Medicare (instead of Medicare) will decide on how much it will cover and how much you will pay for the services you get. You may go to any Medicare approved doctor or hospital or any other health care provider that accepts both Medicare and your plans payment. A PFFS plan has no provider network, and you dont need a referral or a primary care physician for any health care or services. PFFS plans are the most flexible but a doctor will make a visit-by-visit decisions on whether to accept your provider.

Arkansas Blue Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for BlueMedicare Preferred (PFFS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Arkansas Blue Medicare 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 Arkansas Blue Medicare except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

Ready to Enroll?

Click Here

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

2022 Arkansas Blue Medicare Medicare Advantage Plan Costs

BlueMedicare Preferred (PFFS) Part-C Premium

Arkansas Blue Medicare charges a $25.60 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.

H4213-017 Part-D Deductible and Premium

BlueMedicare Preferred (PFFS) has a monthly drug premium of $34.40 and a $480.00 drug deductible. This Arkansas Blue Medicare plan offers a $34.40 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 Arkansas Blue Medicare 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 $34.40 . 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.

Arkansas Blue Medicare 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 Arkansas Blue Medicare 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 BlueMedicare Preferred (PFFS) medicare insurance offers a $7.70 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $14.40 for 75% low income subsidy $21.00 for 50% and $27.70 for 25%.

H4213-017 Formulary or Drug Coverage

BlueMedicare Preferred (PFFS) 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 BlueMedicare Preferred (PFFS) H4213-017 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	$5
Tier 2	NA	$20
Tier 3	NA	$47
Tier 4	NA	41%
Tier 5	NA	25%

*Initial Coverage Phase and 30 day supply

2021 BlueMedicare Preferred (PFFS) Summary of Benefits

*This will be updated with 2022 data when available.

---

Additional Benefits

No

---

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

$1,000 Out-of-network

---

Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$0-340 copay or 40% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$0-340 copay
Diagnostic tests and procedures	0-20% coinsurance
Diagnostic tests and procedures	0-40% coinsurance (Out-of-Network)
Lab services	$0 copay
Lab services	$0 copay or 40% coinsurance (Out-of-Network)
Outpatient x-rays	0-40% coinsurance (Out-of-Network)
Outpatient x-rays	20% coinsurance

---

Doctor Visits

Primary	$30 copay per visit
Primary	$30 copay or 40% coinsurance per visit (Out-of-Network)
Specialist	$50 copay per visit
Specialist	$50 copay or 40% coinsurance per visit (Out-of-Network)

---

Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$50 copay per visit (always covered)

---

Foot Care (podiatry services)

Foot exams and treatment	$50 copay
Foot exams and treatment	$50 copay or 40% coinsurance (Out-of-Network)
Routine foot care	Not covered

---

Ground Ambulance

$265 copay or 20% coinsurance (Out-of-Network)
$265 copay

---

Hearing

Fitting/evaluation	$0-999 copay (Out-of-Network)
Fitting/evaluation	$0 copay
Hearing aids	$699-999 copay
Hearing aids	$0-999 copay (Out-of-Network)
Hearing exam	$50 copay or 40% coinsurance (Out-of-Network)
Hearing exam	$50 copay

---

Inpatient Hospital Coverage

40% per stay $390 per day for days 1 through 5 $0 per day for days 6 through 90 (Out-of-Network)
$390 per day for days 1 through 5 $0 per day for days 6 through 90

---

Medical Equipment/Supplies

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

---

Medicare Part B Drugs

Chemotherapy	20% coinsurance
Chemotherapy	0-40% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance
Other Part B drugs	0-40% coinsurance (Out-of-Network)

---

Mental Health Services

Inpatient hospital - psychiatric	$320 per day for days 1 through 5 $0 per day for days 6 through 90
Inpatient hospital - psychiatric	40% per stay $320 per day for days 1 through 5 $0 per day for days 6 through 90 (Out-of-Network)
Outpatient group therapy visit	$40 copay or 40% coinsurance (Out-of-Network)
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit with a psychiatrist	$40 copay or 40% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit	$40 copay or 40% coinsurance (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 or 40% coinsurance (Out-of-Network)

---

MOOP

$7,500 In and Out-of-network

---

Option

No

---

Optional supplemental benefits

No

---

Outpatient Hospital Coverage

$340 copay per visit
$340 copay or 40% coinsurance per visit (Out-of-Network)

---

Preventive Care

$0 copay
$0 copay or 40% coinsurance (Out-of-Network)

---

Preventive Dental

Cleaning	0-50% coinsurance (Out-of-Network)
Cleaning	$10 copay
Dental x-ray(s)	0-50% coinsurance (Out-of-Network)
Dental x-ray(s)	$0 copay
Fluoride treatment	Not covered
Oral exam	$0 copay
Oral exam	0-50% coinsurance (Out-of-Network)

---

Rehabilitation Services

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

---

Skilled Nursing Facility

$0 per day for days 1 through 20 $184 per day for days 21 through 100
40% per stay $0 per day for days 1 through 20 $184 per day for days 21 through 100 (Out-of-Network)

---

Transportation

Not covered

---

Vision

Contact lenses	Not covered
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	Not covered
Other	Not covered
Routine eye exam	Not covered
Upgrades	Not covered

---

Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for BlueMedicare Preferred (PFFS) H4213

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in BlueMedicare Preferred (PFFS) Plans Performance

Health Plan Customer Service Rating for BlueMedicare Preferred (PFFS)

BlueMedicare Preferred (PFFS) 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 BlueMedicare Preferred (PFFS)

(Click county to compare all available Advantage plans)

Go to top

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.