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Compare Florida Blue Medicare Advantage Plans

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Florida Blue Medicare Advantage

BlueMedicare Value (PPO)

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$
per month

Florida Blue Medicare Advantage

BlueMedicare Premier (HMO)

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$
per month

Coverage Summary

Is My Doctor In-Network?

Primary Care Doctor Visit

Level 1 $0 Copayment in-network
Level 2 (All Other) $10 Copayment in-network

$0 copay

Specialist Visit

Level 1 $30 Copayment in-network
Level 2 (All Other) $43 Copayment in-network

$10 copay

Inpatient Hospital Care

$295 copay per day for days 1-5 in-network

$125 copay per day for days 1-6

Emergency Services (In and out-of-network)

$90 copay; ER copay waived if admitted

$115 copay; ER copay waived if admitted

Urgent Care Services

$40 copay in and out-of-network

$10 copay in and out-of-network

Prescription Drug Coverage

Prescription Drug Deductible

$150 (applies to Tiers 3,4,5 only)

$0

In-Network Prescription Drug Coverage - Initial Coverage

Tier 1 - Preferred Generics

Standard Retail (31-day supply): $0 copay
Standard Retail (90-day supply): $0 copay
Mail Order (90-day supply): $0 copay

Tier 2 - Generics

Standard Retail (31-day supply): $8 copay
Standard Retail (90-day supply):$24 copay
Mail Order (90-day supply): $24 copay

Tier 3 - Preferred Brands

Standard Retail (31-day supply): $47 copay
Standard Retail (90-day supply): $141 copay
Mail Order (90-day supply): $141 copay

Tier 4 - Non-Preferred Drugs

Standard Retail (31-day supply): $100 copay
Standard Retail (90-day supply): $300 copay
Mail Order (90-day supply): $300 copay

Tier 5 - Specialty Drugs

All Locations (31-day supply): 30% of the costs

Tier 6 - Select Care Drugs

All Locations (31-day supply): $0 copay
All Locations (90-day supply): $0 copay

Tier 1 - Preferred Generics

Preferred Retail (31-day supply): $0 copay
Standard Retail (31-day supply): $10 copay
Preferred Retail (90-day supply): $0 copay
Standard Retail (90-day supply): $30 copay
Mail Order (90-day supply): $0 copay

Tier 2 - Generics

Preferred Retail (31-day supply): $0 copay
Standard Retail (31-day supply): $15 copay
Preferred Retail (90-day supply): $0 copay
Standard Retail (90-day supply): $45 copay
Mail Order (90-day supply): $0 copay

Tier 3 - Preferred Brands

Preferred Retail (31-day supply): $30 copay
Standard Retail (31-day supply): $47 copay
Preferred Retail (90-day supply): $90 copay
Standard Retail (90-day supply): $141 copay
Mail Order (90-day supply): $90 copay

Tier 4 - Non-Preferred Drugs

Preferred Retail (31-day supply): $90 copay
Standard Retail (31-day supply): $100 copay
Preferred Retail (90-day supply): $270 copay
Standard Retail (90-day supply): $300 copay
Mail Order (90-day supply): $270 copay

Tier 5 - Specialty Drugs

All Locations (31-day supply): 33% of the costs

Coverage Gap

This plan has coverage in the Part D coverage gap. Tier 1 (preferred generic drugs) and Tier 6 (select care) medications are covered in the coverage gap. For these tiers, you continue to pay the same cost-sharing amounts as in the Initial Coverage Stage. You pay no more than $0 for Tier 1 medications at a network retail pharmacy. You pay no more than $0 for Tier 6 medications at a network retail pharmacy. You will pay no more than 25% of the costs for generics in all other tiers. For all brand drugs you pay no more than 25% of the costs.

This plan has coverage in the Part D coverage gap. Tier 1 (preferred generic drugs) and Tier 2 (generics) medications are covered in the coverage gap. For these tiers, you continue to pay the same cost-sharing amounts as in the Initial Coverage Stage. You pay no more than $0 for Tier 1 medications at a preferred pharmacy. You pay no more than $0 for Tier 2 medications at a preferred pharmacy. You will pay no more than 25% of the costs for generics in all other tiers. For all brand drugs you pay no more than 25% of the costs.

Catastrophic Coverage

You pay the greater of $3.95 or 5% for generic drugs and drugs treated like generics. You pay the greater of $9.85 or 5% for brand name drugs.

You pay the greater of $3.95 or 5% for generic drugs and drugs treated like generics. You pay the greater of $9.85 or 5% for brand name drugs.

Extra Coverage

Extra Benefits

Routine Dental
Routine Vision
Routine Hearing
SilverSneakers Fitness Program
Telehealth Services
At Home Care
Caregiver Support
Over-the-Counter
Health Education

Routine Dental
Routine Vision
Routine Hearing
SilverSneakers Fitness Program
Routine Transportation
Over-the-Counter Items Allowance
Telehealth Services
At Home Care
Caregiver Support
Health Education

Out of Network Coverage

Medical Services/Supplies

If you receive care from an out-of-network provider, your out-of-pocket costs will usually be higher than if you use a network provider. There are three exceptions: emergency care, urgently needed care and dialysis services. For details about the plan's coverage of out-of-network care, please refer to the Summary of Benefits or the Evidence of Coverage. (See "Plan Documents" below.)

If you receive care from an out-of network provider without prior authorization from our plan, the care will not be covered except for emergency care, urgently needed care and dialysis services.

Prescription Drugs

We generally cover drugs filled at an out-of-network pharmacy only if you are not able to use one of our network pharmacies (for example, because you are traveling, need emergency or urgent care, or need a drug that it not available at an accessible network pharmacy). Chapter 5 of the Evidence of Coverage provides a full list of situations in which we may cover drugs from an out-of-network pharmacy.

We generally cover drugs filled at an out-of-network pharmacy only if you are not able to use one of our network pharmacies (for example, because you are traveling, need emergency or urgent care, or need a drug that it not available at an accessible network pharmacy). Chapter 5 of the Evidence of Coverage provides a full list of situations in which we may cover drugs from an out-of-network pharmacy.

Plan Documents

Summary of Benefits (PDF)
Evidence of Coverage (PDF)
Plan Rating (PDF)
General Transition Notice (PDF)
Low Income Subsidy Premium Summary Table for Those Receiving Extra Help (PDF)
Comprehensive Formulary (PDF)
Service Area Map
Annual Notice of Change
Enrollment Forms
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