Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) By Blue Cross and Blue Shield of IL, NM
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) is a 2022 Medicare Advantage Special Needs Plan plan by Blue Cross and Blue Shield of IL, NM. This plan from Blue Cross and Blue Shield of IL, NM works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up 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 IL, NM and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) H8634-009 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.
2022 Medicare Special Needs Plan Details
| Plan Name: | Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) |
|---|---|
| Plan ID: | H8634-009 |
| Special Needs Type: | Dual-Eligible |
| Provider: | Blue Cross and Blue Shield of IL, NM |
| Plan Year: | 2022 |
| Plan Type: | Local PPO |
| Monthly Premium C+D: | $18.30 |
| Part C Premium: | $0.00 |
| Part D (Drug) Premium: | $18.30 |
| Part D Supplemental Premium | $0.00 |
| Total Part D Premium: | $18.30 |
| Drug Deductible: | $480.00 |
| Tiers with No Deductible: | 0 |
| Benchmark: | below the regional benchmark |
| Type of Medicare Health Plan: | Defined Standard Benefit |
| Drug Benefit Type: | Basic | Gap Coverage: | No Gap Coverage |
The Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) H8634-009 is available to residents in New Mexico, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) 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.
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 brand-name drugs and 25% on generic drugs unless your plan offers additional coverage. This Blue Cross and Blue Shield of IL, NM plan offer additional coverage through the gap.
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) Part-C Premium
Blue Cross and Blue Shield of IL, NM plan 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.
H8634-009 Part-D Deductible and Premium
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) has a monthly drug premium of $18.30 and a $480.00 drug deductible. This Blue Cross and Blue Shield of IL, NM plan offers a $18.30 Part D Basic Premium that is 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 IL, NM 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 $18.30 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Blue Cross and Blue Shield of IL, NM 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 IL, NM plan 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 MA Dual Care Plus Preferred (PPO D-SNP) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $4.60 for 75% low income subsidy $9.10 for 50% and $13.70 for 25%.
| Full LIS Premium: | $0.00 |
|---|---|
| 75% LIS Premium: | $4.60 |
| 50% LIS Premium: | $9.10 |
| 25% LIS Premium: | $13.70 |
H8634-009 Formulary or Drug Coverage
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) 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 MA Dual Care Plus Preferred (PPO D-SNP) H8634-009 Formulary here.
| Drug Tier | Copay Preferred Pharmacy |
Copay Nonpreferred Pharmacy |
|---|---|---|
| Tier 1 | NA | 15% |
Reviews for Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) H8634
| 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 Cross MA Dual Care Plus Preferred (PPO D-SNP) Plans Performance
| Total Rating | ||
|---|---|---|
| Complaints about Health Plan | ||
| Members Leaving the Plan | ||
| Health Plan Quality Improvement |
Health Plan Customer Service Rating for Blue Cross MA Dual Care Plus Preferred (PPO D-SNP)
| Total Customer Service Rating | ||
|---|---|---|
| Timely Decisions About Appeals | ||
| Reviewing Appeals Decisions | ||
| Call Center, TTY, Foreign Language |
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) 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 |
Coverage Area for Blue Cross MA Dual Care Plus Preferred (PPO D-SNP)
Source: CMS.
Plans as of September 1, 2021.
Notes: Data are subject to change. All contracts for 2022 have not been finalized. For 2022, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.
Includes 2022 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.