2023 Secure Blue Courage (PPO)

Secure Blue Courage (PPO) H1302-004 is a 2023 Medicare Advantage Plan or Part-C by Blue Cross of Idaho available to residents in Idaho. This plan does not provide extra prescription drug (Part-D) coverage. Blue Cross of Idaho Secure Blue Courage (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,600 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $5,600 out-of-pocket. This can be an extremely nice safety net.

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 extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Blue Cross of Idaho 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 Blue Cross of Idaho except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Idaho.

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Benefits
Monthly Costs
MOOP
Coverage Area

2023 Blue Cross of Idaho Medicare Advantage Plan Overview

Name:	Secure Blue Courage (PPO)
Plan ID:	H1302 004 0
Provider:	Blue Cross of Idaho
Year:	2023
Type:	Local PPO *
Combined Premium (C+D):	$0/mo
MOOP:	$5,600/yr
Similar Plan:	H1302-004

What type of plan is Secure Blue Courage (PPO)

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.

How much does Secure Blue Courage (PPO) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Blue Cross of Idaho charges a $0 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.

MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Secure Blue Courage (PPO) by Blue Cross of Idaho MOOP is $5,600. Once you spend $5,600 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.

2023 Summary of Benefits

The benefit information provided is a summary of what Secure Blue Courage (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Blue Cross of Idaho 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

Contact lenses

In-Network Vision	$0-35 copay
Out-of-Network Vision	$35 copay

Eyeglass frames

Vision	Not covered

Eyeglass lenses

Vision	Not covered

Eyeglasses (frames and lenses)

In-Network Vision	$35 copay
Out-of-Network Vision	$35 copay

Other

Vision	Not covered

Routine eye exam

In-Network Vision	$20 copay
Out-of-Network Vision	$20 copay

Upgrades

Out-of-Network Vision	$35 copay
In-Network Vision	$0 copay

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	$100 per day for days 1 through 12 $196 per day for days 13 through 100

Occupational therapy visit

In-Network Rehabilitation services	$40 copay
Out-of-Network Rehabilitation services	$45 copay

Physical therapy and speech and language therapy visit

In-Network Rehabilitation services	$40 copay
Out-of-Network Rehabilitation services	$45 copay

Cleaning

Preventive dental	Covered under office visit

Dental x-ray(s)

Preventive dental	Covered under office visit

Fluoride treatment

Preventive dental	Covered under office visit

Office visit

In-Network Preventive dental	$25.00
Out-of-Network Preventive dental	50% coinsurance

Oral exam

Preventive dental	Covered under office visit

In-Network Preventive care	$0 copay
Out-of-Network Preventive care	$0 copay
In-Network Outpatient hospital coverage	$325 copay per visit
Out-of-Network Outpatient hospital coverage	20% coinsurance per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

Inpatient hospital - psychiatric

In-Network Mental health services	$350 per day for days 1 through 5 $0 per day for days 6 through 90
Out-of-Network Mental health services	$350 per day for days 1 through 10 $0 per day for days 11 through 90

Outpatient group therapy visit

In-Network Mental health services	$0 copay
Out-of-Network Mental health services	25% coinsurance

Outpatient group therapy visit with a psychiatrist

In-Network Mental health services	$40 copay
Out-of-Network Mental health services	25% coinsurance

Outpatient individual therapy visit

Out-of-Network Mental health services	25% coinsurance
In-Network Mental health services	$0 copay

Outpatient individual therapy visit with a psychiatrist

Out-of-Network Mental health services	25% coinsurance
In-Network Mental health services	$40 copay

Chemotherapy

In-Network Medicare Part B drugs	20% coinsurance
Out-of-Network Medicare Part B drugs	30% coinsurance

Other Part B drugs

Out-of-Network Medicare Part B drugs	30% coinsurance
In-Network Medicare Part B drugs	20% coinsurance

Diabetes supplies

In-Network Medical equipment/supplies	$0 copay
Out-of-Network Medical equipment/supplies	30% coinsurance per item

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

Out-of-Network Medical equipment/supplies	30% coinsurance per item
In-Network Medical equipment/supplies	20% coinsurance per item

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

Out-of-Network Medical equipment/supplies	30% coinsurance per item
In-Network Medical equipment/supplies	20% coinsurance per item

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$7,000 In and Out-of-network $5,600 In-network
Out-of-Network Inpatient hospital coverage	$350 per day for days 1 through 10 $0 per day for days 11 through 90
In-Network Inpatient hospital coverage	$350 per day for days 1 through 5 $0 per day for days 6 through 90

Fitting/evaluation

Hearing	Not covered

Hearing aids

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

Hearing exam

In-Network Hearing	$40 copay
Out-of-Network Hearing	$45 copay

Health plan deductible	$0
In-Network Ground ambulance	$275 copay
Out-of-Network Ground ambulance	$275 copay

Foot exams and treatment

In-Network Foot care (podiatry services)	$40 copay
Out-of-Network Foot care (podiatry services)	$45 copay

Routine foot care

Foot care (podiatry services)	Not covered

Emergency

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

Urgent care

Emergency care/Urgent care	$40 copay per visit (always covered)

Primary

Out-of-Network Doctor visits	$45 copay per visit
In-Network Doctor visits	$0 copay

Specialist

In-Network Doctor visits	$40 copay per visit
Out-of-Network Doctor visits	$45 copay per visit

Diagnostic radiology services (e.g., MRI)

In-Network Diagnostic procedures/lab services/imaging	$250 copay
Out-of-Network Diagnostic procedures/lab services/imaging	25% coinsurance

Diagnostic tests and procedures

In-Network Diagnostic procedures/lab services/imaging	$30 copay or 10% coinsurance
Out-of-Network Diagnostic procedures/lab services/imaging	25% coinsurance

Lab services

Out-of-Network Diagnostic procedures/lab services/imaging	25% coinsurance
In-Network Diagnostic procedures/lab services/imaging	$0 copay

Outpatient x-rays

In-Network Diagnostic procedures/lab services/imaging	$15 copay
Out-of-Network Diagnostic procedures/lab services/imaging	25% coinsurance

Diagnostic services

Comprehensive dental	Not covered

Endodontics

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

Extractions

Out-of-Network Comprehensive dental	50% coinsurance
In-Network Comprehensive dental	$25 copay

Non-routine services

In-Network Comprehensive dental	$25 copay
Out-of-Network Comprehensive dental	50% coinsurance

Periodontics

In-Network Comprehensive dental	$25 copay
Out-of-Network Comprehensive dental	50% coinsurance

Prosthodontics, other oral/maxillofacial surgery, other services

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

Restorative services

In-Network Comprehensive dental	$25 copay
Out-of-Network Comprehensive dental	50% coinsurance

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

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 Secure Blue Courage (PPO) requires you to live in that plan’s service area. The service area is listed below:

State:

Idaho Medicare

County:

Ada County MA Plans

Adams County MA Plans

Bannock County MA Plans

Bingham County MA Plans

Blaine County MA Plans

Boise County MA Plans

Bonner County MA Plans

Bonneville County MA Plans

Boundary County MA Plans

Canyon County MA Plans

Cassia County MA Plans

Clark County MA Plans

Elmore County MA Plans

Fremont County MA Plans

Gem County MA Plans

Gooding County MA Plans

Jefferson County MA Plans

Jerome County MA Plans

Kootenai County MA Plans

Latah County MA Plans

Lincoln County MA Plans

Madison County MA Plans

Minidoka County MA Plans

Nez Perce County MA Plans

Owyhee County MA Plans

Payette County MA Plans

Power County MA Plans

Shoshone County MA Plans

Twin Falls County MA Plans

Valley County MA Plans

Washington County MA Plans

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How much does Secure Blue Courage (PPO) cost?

Blue Cross of Idaho charges a $0 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is Secure Blue Courage (PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Secure Blue Courage (PPO) by Blue Cross of Idaho MOOP is $5,600. Once you spend $5,600 you will pay nothing for Part A or Part B covered services.

What type of plan is Secure Blue Courage (PPO)?

Secure Blue Courage (PPO) is a Local PPO *. A (PPO) is a Medicare plan that has contracts with a network of preferred providers. You do not need to select a primary care physician and you do not need referrals to see other providers in the network.

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.