BlueMedicare Preferred (PFFS) H4213-017 is a 2023 Medicare Advantage Plan or Part-C by Arkansas Blue Medicare available to residents in Arkansas. This plan includes extra prescription drug (Part-D) coverage. Arkansas Blue Medicare BlueMedicare Preferred (PFFS) has a monthly premium of $59.00 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 an extremely nice safety net.

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 extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Arkansas Blue Medicare and not Original Medicare. With 2023 Medicare Advantage Plan 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 if you sign up for Medicare Advantage in Arkansas.

2023 Arkansas Blue Medicare Medicare Advantage Plan Overview

What type of plan is BlueMedicare Preferred (PFFS)

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.

How much does BlueMedicare Preferred (PFFS) cost?

Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Arkansas Blue Medicare charges a $59.00 consolidated premium. The Part C premium is $20.50 this charge covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

Part-D Deductible and Premium

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. BlueMedicare Preferred (PFFS) has a monthly drug premium of $38.50 and a $505.00 drug deductible. This Arkansas Blue Medicare plan offers a $38.50 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. This Premium covers any enhanced plan benefits offered by Arkansas Blue Medicare above and beyond the standard PDP benefits. This can include extra coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $38.50. The Part D Total Premium is the addition of 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 2023 once you and your plan provider have spent $4660 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 extra coverage. This Arkansas Blue Medicare plan does not offer extra coverage through the gap.

Extra Help Premium Assistance

The Low Income Subsidy (LIS) Extra Helps people with Medicare pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The 2022 income limit is $1,719 ($2,309 for couples) per month. Depending on your income level you may be eligible for a full 75%, 50%, 25% premium assistance. The BlueMedicare Preferred (PFFS) medicare insurance offers a $6.60 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $14.60 for 75% low-income subsidy $22.50 for 50% and $30.50 for 25%.

Formulary and 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.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	$15
Tier 2	NA	$20
Tier 3	NA	$47
Tier 4	NA	32%
Tier 5	NA	25%
Tier 6	NA	$0

The complete BlueMedicare Preferred (PFFS) Formulary.
*Initial Coverage Phase and 30 day supply

2023 Summary of Benefits

The benefit information provided is a summary of what BlueMedicare Preferred (PFFS) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Arkansas Blue Medicare helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)	Covered

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Contact lenses

Vision	Not covered

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Eyeglass frames

Vision	Not covered

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Eyeglass lenses

Vision	Not covered

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Eyeglasses (frames and lenses)

Vision	Not covered

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Other

Vision	Not covered

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Routine eye exam

Vision	Not covered

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Upgrades

Vision	Not covered

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Transportation	Not covered
In-Network Skilled Nursing Facility	$0 per day for days 1 through 20 $196 per day for days 21 through 100
Out-of-Network Skilled Nursing Facility	40% per stay $0 per day for days 1 through 20 $196 per day for days 21 through 100

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Occupational therapy visit

In-Network Rehabilitation services	$40 copay
Out-of-Network Rehabilitation services	$35-40 copay or 40% coinsurance

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Physical therapy and speech and language therapy visit

Out-of-Network Rehabilitation services	$35-40 copay or 40% coinsurance
In-Network Rehabilitation services	$40 copay

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Cleaning

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	0-50% coinsurance

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Dental x-ray(s)

Out-of-Network Preventive dental	0-50% coinsurance
In-Network Preventive dental	$0 copay

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Fluoride treatment

Preventive dental	Not covered

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Oral exam

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	0-50% coinsurance

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In-Network Preventive care	$0 copay
Out-of-Network Preventive care	$0 copay or 40% coinsurance
In-Network Outpatient hospital coverage	$340 copay per visit
Out-of-Network Outpatient hospital coverage	$340 copay or 40% coinsurance per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

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Inpatient hospital - psychiatric

In-Network Mental health services	$320 per day for days 1 through 5 $0 per day for days 6 through 90
Out-of-Network Mental health services	40% per stay $320 per day for days 1 through 5 $0 per day for days 6 through 90

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Outpatient group therapy visit

In-Network Mental health services	$35 copay
Out-of-Network Mental health services	$35-40 copay or 40% coinsurance

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Outpatient group therapy visit with a psychiatrist

Out-of-Network Mental health services	$35-40 copay or 40% coinsurance
In-Network Mental health services	$35 copay

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Outpatient individual therapy visit

In-Network Mental health services	$35 copay
Out-of-Network Mental health services	$35-40 copay or 40% coinsurance

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Outpatient individual therapy visit with a psychiatrist

In-Network Mental health services	$35 copay
Out-of-Network Mental health services	$35-40 copay or 40% coinsurance

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Chemotherapy

Out-of-Network Medicare Part B drugs	0-40% coinsurance
In-Network Medicare Part B drugs	20% coinsurance

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Other Part B drugs

Out-of-Network Medicare Part B drugs	0-40% coinsurance
In-Network Medicare Part B drugs	20% coinsurance

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Diabetes supplies

Out-of-Network Medical equipment/supplies	20% coinsurance per item
In-Network Medical equipment/supplies	$0 copay per item

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Durable medical equipment (e.g., wheelchairs, oxygen)

In-Network Medical equipment/supplies	20% coinsurance per item
Out-of-Network Medical equipment/supplies	20% coinsurance per item

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Prosthetics (e.g., braces, artificial limbs)

Out-of-Network Medical equipment/supplies	20% coinsurance per item
In-Network Medical equipment/supplies	20% coinsurance per item

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$7,500 In and Out-of-network
In-Network Inpatient hospital coverage	$390 per day for days 1 through 5 $0 per day for days 6 through 90
Out-of-Network Inpatient hospital coverage	40% per stay $390 per day for days 1 through 5 $0 per day for days 6 through 90

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Fitting/evaluation

In-Network Hearing	$0 copay
Out-of-Network Hearing	$0-999 copay

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Hearing aids

In-Network Hearing	$699-999 copay
Out-of-Network Hearing	$0-999 copay

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Hearing exam

Out-of-Network Hearing	$50 copay or 40% coinsurance
In-Network Hearing	$50 copay

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Health plan deductible	$1,000 Out-of-network
In-Network Ground ambulance	$265 copay
Out-of-Network Ground ambulance	$265 copay or 20% coinsurance

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Foot exams and treatment

Out-of-Network Foot care (podiatry services)	$50 copay or 40% coinsurance
In-Network Foot care (podiatry services)	$50 copay

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Routine foot care

Foot care (podiatry services)	Not covered

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Emergency

Emergency care/Urgent care	$95 copay per visit (always covered)

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Urgent care

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

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Primary

In-Network Doctor visits	$20 copay per visit
Out-of-Network Doctor visits	$20 copay or 40% coinsurance per visit

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Specialist

In-Network Doctor visits	$50 copay per visit
Out-of-Network Doctor visits	$50 copay or 40% coinsurance per visit

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Diagnostic radiology services (e.g., MRI)

In-Network Diagnostic procedures/lab services/imaging	$0-340 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$0-340 copay or 40% coinsurance

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Diagnostic tests and procedures

In-Network Diagnostic procedures/lab services/imaging	0-20% coinsurance
Out-of-Network Diagnostic procedures/lab services/imaging	0-40% coinsurance

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Lab services

In-Network Diagnostic procedures/lab services/imaging	$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$0 copay or 40% coinsurance

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Outpatient x-rays

In-Network Diagnostic procedures/lab services/imaging	20% coinsurance
Out-of-Network Diagnostic procedures/lab services/imaging	0-40% coinsurance

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Diagnostic services

Comprehensive dental	Not covered

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Endodontics

Comprehensive dental	Not covered

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Extractions

In-Network Comprehensive dental	$20 copay
Out-of-Network Comprehensive dental	0-50% coinsurance

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Non-routine services

Comprehensive dental	Not covered

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Periodontics

Out-of-Network Comprehensive dental	0-50% coinsurance
In-Network Comprehensive dental	50% coinsurance

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Prosthodontics, other oral/maxillofacial surgery, other services

In-Network Comprehensive dental	$20 copay or 50% coinsurance
Out-of-Network Comprehensive dental	0-50% coinsurance

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Restorative services

In-Network Comprehensive dental	50% coinsurance
Out-of-Network Comprehensive dental	0-50% coinsurance

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In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	No

BlueMedicare Preferred (PFFS) Reviews

Is BlueMedicare Preferred (PFFS) a good plan? BlueMedicare Preferred (PFFS) received a 3.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare BlueMedicare Preferred Reviews among several different plans.

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with H4213-017 Health Plan

Member Complaints and Changes in Plans Performance

Health Plan Customer Service Rating for Arkansas Blue Medicare

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

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for BlueMedicare Preferred (PFFS) requires you to live in that plan’s service area. The service area is listed below:

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Source:CMS. Data as of Oct 1, 2022.

Last updated on December 03, 2022

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.