2022 Secure Blue Courage (PPO)
Secure Blue Courage (PPO) H1302-004 is a 2022 Medicare Advantage Plan or Part-C by Blue Cross of Idaho available to residents in Idaho. This plan does not provide additional prescription drug (Part-D) coverage. The Secure Blue Courage (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $3,400 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay
$3,400 out-of-pocket. This can be a extremely nice safety net.
Secure Blue Courage (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 of Idaho works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Secure Blue Courage (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Blue Cross of Idaho 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 of Idaho 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 of Idaho Medicare Advantage Plan Costs
| Name: | Secure Blue Courage (PPO) |
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| Plan ID: | H1302-004 |
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| Provider: | Blue Cross of Idaho |
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| Year: | 2022 |
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| Type: | Local PPO * |
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| Monthly Premium C+D: | $0 |
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| Part C Premium: | |
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| MOOP: | $3,400 |
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| Similar Plan: | H1302-004 |
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| New Plan: | 2023 H1302-004 |
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2021 Secure Blue Courage (PPO) Summary of Benefits
*This will be updated with 2022 data when available.
Additional Benefits
Comprehensive Dental
| Diagnostic services |
Not covered |
| Endodontics |
50% coinsurance (Out-of-Network) |
| Endodontics |
50% coinsurance |
| Extractions |
$0 copay |
| Extractions |
50% coinsurance (Out-of-Network) |
| Non-routine services |
50% coinsurance (Out-of-Network) |
| Non-routine services |
$0 copay |
| Periodontics |
50% coinsurance (Out-of-Network) |
| Periodontics |
50% coinsurance |
| Prosthodontics, other oral/maxillofacial surgery, other services |
50% coinsurance |
| Prosthodontics, other oral/maxillofacial surgery, other services |
50% coinsurance (Out-of-Network) |
| Restorative services |
$0 copay |
| Restorative services |
50% coinsurance (Out-of-Network) |
Deductible
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) |
$250 copay |
| Diagnostic radiology services (e.g., MRI) |
25% coinsurance (Out-of-Network) |
| Diagnostic tests and procedures |
10% coinsurance |
| Diagnostic tests and procedures |
25% coinsurance (Out-of-Network) |
| Lab services |
$0 copay |
| Lab services |
25% coinsurance (Out-of-Network) |
| Outpatient x-rays |
$0 copay |
| Outpatient x-rays |
25% coinsurance (Out-of-Network) |
Doctor Visits
| Primary |
$30 copay per visit (Out-of-Network) |
| Primary |
$0 copay |
| Specialist |
$25 copay per visit |
| Specialist |
$30 copay per visit (Out-of-Network) |
Emergency care/Urgent Care
| Emergency |
$90 copay per visit (always covered) |
| Urgent care |
$25 copay per visit (always covered) |
Foot Care (podiatry services)
| Foot exams and treatment |
$30 copay (Out-of-Network) |
| Foot exams and treatment |
$25 copay |
| Routine foot care |
Not covered |
Ground Ambulance
| $175 copay (Out-of-Network) |
|
|
| $175 copay |
|
|
Hearing
| Fitting/evaluation |
Not covered |
| Hearing aids |
$699-999 copay |
| Hearing aids |
$699-999 copay (Out-of-Network) |
| Hearing exam |
$25 copay |
| Hearing exam |
$45 copay (Out-of-Network) |
Inpatient Hospital Coverage
$100 per day for days 1 through 5
$0 per day for days 6 through 90 |
|
|
$200 per day for days 1 through 10
$0 per day for days 11 through 90 (Out-of-Network) |
|
|
Medical Equipment/Supplies
| Diabetes supplies |
$0 copay |
| Diabetes supplies |
20% coinsurance per item (Out-of-Network) |
| Durable medical equipment (e.g., wheelchairs, oxygen) |
10% coinsurance per item |
| Durable medical equipment (e.g., wheelchairs, oxygen) |
20% coinsurance per item (Out-of-Network) |
| Prosthetics (e.g., braces, artificial limbs) |
10% coinsurance per item |
| Prosthetics (e.g., braces, artificial limbs) |
20% coinsurance per item (Out-of-Network) |
Medicare Part B Drugs
| Chemotherapy |
30% coinsurance (Out-of-Network) |
| Chemotherapy |
20% coinsurance |
| Other Part B drugs |
20% coinsurance |
| Other Part B drugs |
30% coinsurance (Out-of-Network) |
Mental Health Services
| Inpatient hospital - psychiatric |
$100 per day for days 1 through 5
$0 per day for days 6 through 90 |
| Inpatient hospital - psychiatric |
$200 per day for days 1 through 10
$0 per day for days 11 through 90 (Out-of-Network) |
| Outpatient group therapy visit |
$0 copay |
| Outpatient group therapy visit |
25% coinsurance (Out-of-Network) |
| Outpatient group therapy visit with a psychiatrist |
$25 copay |
| Outpatient group therapy visit with a psychiatrist |
25% coinsurance (Out-of-Network) |
| Outpatient individual therapy visit |
$0 copay |
| Outpatient individual therapy visit |
25% coinsurance (Out-of-Network) |
| Outpatient individual therapy visit with a psychiatrist |
$25 copay |
| Outpatient individual therapy visit with a psychiatrist |
25% coinsurance (Out-of-Network) |
MOOP
$5,000 In and Out-of-network
$3,400 In-network |
|
|
Option
Optional supplemental benefits
Outpatient Hospital Coverage
| 20% coinsurance per visit (Out-of-Network) |
|
|
| $175 copay per visit |
|
|
Preventive Care
| $0 copay (Out-of-Network) |
|
|
| $0 copay |
|
|
Preventive Dental
| Cleaning |
Covered under office visit |
| Dental x-ray(s) |
Covered under office visit |
| Fluoride treatment |
Covered under office visit |
| Office visit |
$0.00 |
| Office visit |
50% coinsurance (Out-of-Network) |
| Oral exam |
Covered under office visit |
Rehabilitation Services
| Occupational therapy visit |
$30 copay (Out-of-Network) |
| Occupational therapy visit |
$25 copay |
| Physical therapy and speech and language therapy visit |
$30 copay (Out-of-Network) |
| Physical therapy and speech and language therapy visit |
$25 copay |
Skilled Nursing Facility
$0 per day for days 1 through 20
$180 per day for days 21 through 100 |
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|
$100 per day for days 1 through 12
$180 per day for days 13 through 100 (Out-of-Network) |
|
|
Transportation
Vision
| Contact lenses |
$35 copay (Out-of-Network) |
| Contact lenses |
$0-35 copay |
| Eyeglass frames |
Not covered |
| Eyeglass lenses |
Not covered |
| Eyeglasses (frames and lenses) |
$35 copay |
| Eyeglasses (frames and lenses) |
$35 copay (Out-of-Network) |
| Other |
Not covered |
| Routine eye exam |
$20 copay (Out-of-Network) |
| Routine eye exam |
$20 copay |
| Upgrades |
$0 copay |
| Upgrades |
$35 copay (Out-of-Network) |
Wellness Programs (e.g. fitness nursing hotline)
Ready to Enroll?
Click Here |
Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST
Coverage Area for Secure Blue Courage (PPO)
(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.
