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BCBSTX Medicare Advantage Plans

Medicare Advantage Plans


What are Medicare Advantage Plans? 

Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). In most cases, you’ll need to use health care providers who participate in the plan’s network. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services. Some plans offer non-emergency coverage out of network, but typically at a higher cost. Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white, and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare. Below are the most common types of Medicare Advantage Plans.

Medicare Advantage Plans:

  • Replace Part A and Part B
  • Pay for your health care
  • Usually include Part D prescription drug coverage
  • Usually cover routine vision and dental care
  • May have coverage restrictions such as provider networks and prior authorization

    Medicare Advantage Cost:

    • Monthly Premiums: Most people pay $0
    • Deductible: $0 to $500 is typical; you may have a separate deductible of up to $435 for Part D
    • Cost Sharing: Copayments are generally between $5 and $25 for office visits, $50 for urgent care, and $100 per day for the first 5 inpatient days
    • Out-of-pocket Maximum: $4,900 is average, although it can be as high as $6,700

    BCBSTX Access Flex PPO Medicare Advantage Plan

    • New Open-Access PPO Plan
    • New and Enhanced EXTRA BENEFITS –  Dental, OTC, Vision, and Hearing 
    • $0 maximum out-of-pocket
    • $0 inpatient hospital copay
    • $0 copay for telehealth urgent care
    • No-cost SilverSneakers® fitness program, 24/7 Nurseline, Rewards program
    • Ease and Choice: No underwriting, access to any nationwide Medicare provider
    • $0 copay at preferred pharmacies for select prescription drugs 
    • Vision coverage with $0 copay on  routine eye exams 
    • TeleHealth by MDLive 
    • Rewards in up to $100 of gift cards for taking healthy actions 

    2023 MAPD Product Offering

    • Blue Cross Medicare Advantage Flex (PPO)SM
    • Blue Cross Medicare Advantage Basic (HMO)SM
    • Blue Cross Medicare Advantage Choice Plus (PPO)SM*
    • Blue Cross Medicare Advantage Choice Premier (PPO)SM*
    • Blue Cross Medicare Advantage Classic (PPO)SM
    • Blue Cross Medicare Advantage Value (HMO)SM

    Service Area Expansion

    HMO:  Brazoria, Ellis, Johnson, Parker, Rockwell, Waller 

    PPO: Archer, Austin, Bee, Bell, Blanco, Bosque, Burleson, Brazoria, Brazos, Brooks, Clay, Coryell, Dimmit, Duval, Ellis, Erath, Falls, Freestone, Galveston, Goliad, Grimes, Hamilton, Henderson, Hopkins, Houston, Jack, Jefferson, Jim Hogg, Jim Wells, Karnes, Kenedy, La Salle, Limestone, Madison, Mason, McCulloch, McLennan, Mills, Montgomery, Nueces, Orange, Palo Pinto, Parker, Polk, Rains, Refugio, San Jacinto, San Patricio, San Saba, Schakelford, Somervell, Throckmorton, Trinity, Tyler, Van Zandt, Waller, Washington, Webb, Zavala