Blue Advantage Premier (PPO) in Sumter, Alabama (2023)
Blue Advantage Premier (PPO) in Sumter County, Alabama costs $170/mo. This affordable Regional PPO plan (H0104-015) is a top choice for those living in Sumter County with a $0 prescription deductible and out-of-pocket limits at $3,400. Learn more about Medicare Part C by AARP in Sumter County, Alabama below.
UPDATED: Sep 19, 2023
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UPDATED: Sep 19, 2023Fact Checked
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5 out of 5 stars* for plan year 2024
Plan ID: H0104-015
What You Need to Know:
- Blue Advantage Premier (PPO) is a Medicare Advantage Health Maintenance Organization Local PPO plan.
- It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
- It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
- The plan's monthly premium is $170, which does not include your monthly Medicare Part B premium.
- The annual deductible for this health plan is .
- The plan includes an out-of-pocket maximum of $3,400 per year (in-network).
- Blue Advantage Premier (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
- This plan's Part D Initial Coverage Limit is $64.
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$170
Monthly Premium
| Medicare Plan Features | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Monthly Premium: | $170.00 | ||||||||
| Part C Premium: | $106.0 | ||||||||
| Monthly Premium: | Part C Premium: | Part D Drug Premium: | Part D Supplemental Premium: | Total Part D Premium: | Drug Deductible: | Tiers with No Deductible: | |||
| $170.00 | $106.0 | $64.00 | $0 | $64.00 | $0 | 0.0 | |||
| Gap Coverage: | Yes | ||||||||
| Benchmark: | not below the regional benchmark | ||||||||
| Type of Medicare Health: | Enhanced Alternative | ||||||||
| Health Plan Type: | Local PPO | ||||||||
| Similar Plan: | H0104-012 | ||||||||
| Special Needs Type: | NULL | ||||||||
| Chronic Condition: | NULL | ||||||||
| Additional Gap Coverage: | Yes, some additional gap coverage. | ||||||||
| Maximum Out-of-Pocket Limit for Parts A & B (Moop): | $3,400 | ||||||||
| Annual Deductible: | NULL | ||||||||
| Annual Initial Coverage Limit ICL: | $4,130 | ||||||||
| Number of Members enrolled in this plan in Sumter, Alabama: | Plans Summary Star Rating: | Customer Service Rating: | Drug Cost Rating: | ||||||
| less than 10 members | 4 out of 5 Stars. | 5 out of 5 Stars. | 3 out of 5 Stars. | ||||||
| Plan Offers Mail Order: | Yes | ||||||||
| Plan Health Benefits | |||||||||
| Total # of Formulary Drugs: | 3,509 drugs | ||||||||
| Number of Members Enrolled in this Plan in Sumter, Alabama: | 5,381 members | ||||||||
| Number of Drugs Per Tier: | NULL | ||||||||
| Preferred Pharmacy Cost Sharing During Initial Coverage Phase: | NULL | ||||||||
| Special Needs Plan SNP Eligibility Requirement: | NULL | ||||||||
| Monthly Premium Split as Follows: | |||||||||
| Part C Premium | Part D Base Premium | Part D Supplemental Premium | Total Premium | ||||||
| $106.00 | $64.00 | $0.00 | $170.00 | ||||||
| Monthly Premium with Extra Help Low Income Subsidy: | |||||||||
| LIS100 Subsidy Total Monthly Premium with LIS Parts CD | LIS25 Subsidy Monthly PartD Premium with LIS | LIS25 Subsidy Total Monthly Premium with LIS Parts CD | LIS50 Monthly PartD Premium with LIS | LIS50 Subsidy Total Monthly Premium with LIS Parts CD | LIS75 Monthly PartD Premium with LIS | LIS75 Subsidy Total Monthly Premium with LIS Parts CD | |||
| $139.80 | $56.40 | $162.40 | $48.90 | $154.90 | $41.30 | $147.30 | |||
| Formulary Drug Details: | |||||||||
| Tier 1 # of Drugs per Tier | Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) | Tier 2 # of Drugs per Tier | Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) | Tier 3 # of Drugs per Tier | Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) | Tier 4 # of Drugs per Tier | Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) | Tier 5 # of Drugs per Tier | Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase) |
| 293 | $3.00 | 796 | $8.00 | 764 | $40.00 | 730 | 45% | 716 | 33% |
Other Medicare Advantage Plans in Sumter, Alabama
| Plan Name | Type | Premium MOOP | Rx Deduct. | Rating |
|---|---|---|---|---|
| Blue Advantage Complete (PPO) (2023) | Local PPO | $5,100 | $150 | |
| WellCare Absolute (PPO) (2023) | Local PPO | $7,350 | $100 | New plan - not yet rated. |
| WellCare Premier (PPO) (2023) | Local PPO | $5,500 | $0 | New plan - not yet rated. |
| Lasso Healthcare Growth (MSA) (2023) | MSA * | $- | $- | |
| Lasso Healthcare Growth Plus (MSA) (2023) | MSA * | $- | $- | |
| HumanaChoice H5216-179 (PPO) (2023) | Local PPO | $6,700 | $360 | |
| HumanaChoice H5216-214 (PPO) (2023) | Local PPO | $6,700 | $150 | |
| Humana Honor (PPO) (2023) | Local PPO * | $3,400 | $- | |
| WellCare Value (HMO) (2023) | Local HMO | $6,700 | $250 | New plan - not yet rated. |
| WellCare Compass (HMO) (2023) | Local HMO | $4,500 | $445 | New plan - not yet rated. |
| WellCare Essential (HMO) (2023) | Local HMO | $4,900 | $0 | New plan - not yet rated. |
| HumanaChoice R7315-001 (Regional PPO) (2023) | Regional PPO * | $3,400 | $- | |
| HumanaChoice R7315-002 (Regional PPO) (2023) | Regional PPO | $6,700 | $400 | |
| Medicare Advantage Plans by Blue Cross and Blue Shield of Alabama | ||||
| Blue Advantage Complete (PPO) (2023) | Local PPO | $5,100 | $150 | |
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