2022 BlueMedicare Value (PFFS)

BlueMedicare Value (PFFS) H4213-016 is a 2022 Medicare Advantage Plan or Part-C by Arkansas Blue Medicare available to residents in Arkansas. This plan does not provide additional prescription drug (Part-D) coverage. The BlueMedicare Value (PFFS) has a monthly premium of $29.00 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 Value (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 Value (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.

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2022 Arkansas Blue Medicare Medicare Advantage Plan Costs

2021 BlueMedicare Value (PFFS) 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	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

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Deductible

$1,000 Out-of-network

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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 or 40% coinsurance (Out-of-Network)
Lab services	$0 copay
Outpatient x-rays	0-40% coinsurance (Out-of-Network)
Outpatient x-rays	20% coinsurance

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Doctor Visits

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

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Emergency care/Urgent Care

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

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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

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Ground Ambulance

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

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Hearing

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

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Inpatient Hospital Coverage

$372 per day for days 1 through 5 $0 per day for days 6 through 90
40% per stay $372 per day for days 1 through 5 $0 per day for days 6 through 90 (Out-of-Network)

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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 (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
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	0-40% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	20% coinsurance
Other Part B drugs	0-40% coinsurance (Out-of-Network)

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Mental Health Services

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

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MOOP

$7,500 In and Out-of-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

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

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Preventive Care

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

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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)

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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)

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Skilled Nursing Facility

$0 per day for days 1 through 20 $178 per day for days 21 through 100
40% per stay $0 per day for days 1 through 20 $178 per day for days 21 through 100 (Out-of-Network)

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Transportation

Not covered

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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

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for BlueMedicare Value (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 Value (PFFS) Plans Performance

Health Plan Customer Service Rating for BlueMedicare Value (PFFS)

BlueMedicare Value (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 Value (PFFS)

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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.