Plan ID: H3554-003

What You Need to Know:

  • BlueMedicare Value Choice (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 $29, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $250 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $6,700 per year (in-network).
  • BlueMedicare Value Choice (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $250 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $0.

$29

Monthly Premium

Medicare Plan Features
Monthly Premium: $29.00
Part C Premium: $29.00
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$29.00 $29.00 $0 $0 $0 $250.0 1.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H3554-004
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): $6,700
Annual Deductible: $250 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Conway, Arkansas: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
less than 10 members New plan - No summary rating as of yet. New plan - not yet rated. New plan - not yet rated.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 2,801 drugs
Number of Members Enrolled in this Plan in Conway, Arkansas: 99 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
$29.00 $0.00 $0.00 $29.00
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
$29.00 $0.00 $29.00 $0.00 $29.00 $0.00 $29.00
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)
68 $3.00 565 $13.00 687 $47.00 668 50% 673 28%

Other Medicare Advantage Plans in Conway, Arkansas

Plan Name Type Premium MOOP Rx Deduct. Rating
Cigna Preferred Medicare (HMO) (2023)Local HMO$6,700$0
4
HumanaChoice H5216-083 (PPO) (2023)Local PPO$6,700$195
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
HumanaChoice H5216-139 (PPO) (2023)Local PPO$6,700$0
4
Humana Honor (PPO) (2023)Local PPO *$4,500$-
4
AARP Medicare Advantage Plan 1 (HMO) (2023)Local HMO$5,900$250
5
AARP Medicare Advantage Plan 2 (HMO) (2023)Local HMO$4,500$0
5
WellCare Patriot (HMO-POS) (2023)Local HMO *$4,500$-
4
HumanaChoice H5216-163 (PPO) (2023)Local PPO$7,550$195
4
WellCare Dividend (HMO) (2023)Local HMO$6,700$0
4
Aetna Medicare Premier Plus (PPO) (2023)Local PPO$7,550$0
4
Aetna Medicare Elite (PPO) (2023)Local PPO$6,000$0
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
AARP Medicare Advantage Patriot (HMO) (2023)Local HMO *$4,500$-
5
WellCare Premier (PPO) (2023)Local PPO$5,500$0
New plan - not yet rated.
WellCare Compass (HMO) (2023)Local HMO$3,450$445
4
BlueMedicare Premier Choice (PPO) (2023)Local PPO$6,500$195
New plan - not yet rated.
WellCare Preferred (HMO) (2023)Local HMO$6,000$0
4
BlueMedicare Value (PFFS) (2023)PFFS *$-$-
5
BlueMedicare Preferred (PFFS) (2023)PFFS$-$420
5
Humana Gold Choice H8145-120 (PFFS) (2023)PFFS *$-$-
4
Humana Gold Choice H8145-122 (PFFS) (2023)PFFS$-$195
4
HumanaChoice H9070-005 (PPO) (2023)Local PPO$6,700$0
5
Humana Value Plus H5619-109 (HMO) (2023)Local HMO$7,550$445
4
Humana Gold Plus H5619-122 (HMO) (2023)Local HMO$6,700$0
4
Allwell Medicare Premier (HMO) (2023)Local HMO$7,100$250
3
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$5,900$250
5
Allwell Medicare Boost (HMO) (2023)Local HMO$7,550$445
3
Allwell Medicare Simple (HMO) (2023)Local HMO *$4,900$-
3
Health Advantage Blue Premier (HMO) (2023)Local HMO$6,500$250
5
HumanaChoice R1532-001 (Regional PPO) (2023)Regional PPO *$3,900$-
4
HumanaChoice R1532-002 (Regional PPO) (2023)Regional PPO$6,700$400
4
UnitedHealthcare Medicare Advantage Choice Plan 2 (Region (2023)Regional PPO$6,700$295
5
UnitedHealthcare Medicare Advantage Choice Plan 3 (Region (2023)Regional PPO$6,700$245
5
Medicare Advantage Plans by Arkansas Blue Medicare
BlueMedicare Premier Choice (PPO) (2023)Local PPO$6,500$195
New plan - not yet rated.
BlueMedicare Value (PFFS) (2023)PFFS *$-$-
5
BlueMedicare Preferred (PFFS) (2023)PFFS$-$420
5

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