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Blue Advantage Overview

Blue Advantage Plans Include:

  • Comprehensive Medical Coverage >
  • Prescription Drug Coverage >
  • Comprehensive Dental >
  • Vision Exams & Eyewear >
  • Hearing Exams & Hearing Aids >
  • SilverSneakers® Fitness Membership >
  • Choice of plans, including $0 premium option
  • Built-in prescription drug coverage
  • Statewide provider network with 100% of Alabama hospitals and over 90% of doctors
  • No referral required for network specialists, doctors or hospitals
  • In network and out covered services
  • $0 copay for an annual routine vision and hearing exam
  • Significant discounts on hearing aids through TruHearing®
  • $100 eyewear allowance and starting at $1,000 allowance for preventative and comprehensive dental per calendar year
  • FREE fitness allowance FlexCard
  • $0 copay for most preventive services, most immunizations, and lab services
  • Air medical transportation**
  • 24-Hour nurses hotline
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Comprehensive Medical Coverage

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Comprehensive Medical Coverage

 

NO referrals required to see specialists.

You can use providers outside the network.

With over 90% of doctors and EVERY Alabama hospital in the Blue Advantage network, it’s easy to get the in-network doctor you want.

NO COST for many health screenings, immunizations, and other Medicare-recommended preventive services.

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Prescription Drug Coverage

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Prescription Drug Coverage

 

Both Blue Advantage plans have over 1,000+ network pharmacies in Alabama that make it convenient for you to save money.

Your drug cost savings are avaliable at retail pharmacies as well as through Mail-Order. Our Extensive PREFERRED retail pharmacy network includes Kroger, Publix, Sam's Club, Walgreens, Walmart, Winn-Dixie plus HUNDREDS of local independent neighborhood pharmacies!

Click here for ways to ensure you are paying the least amount for your prescriptions with Rx Savings Solutions.

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Comprehensive & Preventive Dental

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Comprehensive & Preventive Dental

 

Our Medicare Advantage plans include a dental allowance designed to provide most comprehensive and preventive services.

$1,000/$1,300 max per calendar year for comprehensive and preventive dental allowance (Blue Advantage Complete / Blue Advantage Premier)

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Vision Exams & Eyewear

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Vision Exams & Eyewear

 

$0 copay for annual routine vision exam

$100 eyewear allowance per calendar year

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Hearing Exams & Hearing Aids

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TruHearing® Services*

 

A comprehensive hearing care solution — $0 copay for an annual routine hearing exam, plus you can get state-of-the-art hearing aids as low as $499, $699 or $999 (one per ear, per year) which can save you thousands of dollars.

*All content ©2023 TruHearing, Inc. All rights reserved. TruHearing® is a registered trademark of TruHearing, Inc. All appointments must be performed by a TruHearing network provider for routine hearing exam and hearing aids.

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Fitness Allowance FlexCard

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Fitness Allowance

 

An innovative health, exercise and wellness benefit for active seniors. Get fit, have fun and make new friends while enjoying a healthy lifestyle.

  • $90 allowance every three months
  • Allowance will be loaded to the FlexCard mailed to you at enrollment
  • Your FlexCard can be used toward memberships at over 450 health clubs in the state of Alabama
  • Any unused amount will not carry over to the next quarter

*The Alabama FlexCard Mastercard® Prepaid card is issued by Stride Bank, N.A., Member FDIC, pursuant to license by Mastercard International.

Blue Advantage makes it easy to stay healthy and save money

  • Choice of plans, including $0 premium option
  • Built-in prescription drug coverage with a $0 drug deductible
  • Statewide provider network with 100% of Alabama hospitals and over  90% of doctors
  • No referral required for network specialists, doctors or hospitals
  • In network and out of network covered services
  • $0 copay for an annual routine vision and hearing exam
  • Significant discounts on hearing aids through TruHearing®***
  • $100 eyewear and starting at $1,000 allowance for preventative and comprehensive dental per calendar year
  • FREE fitness allowance FlexCard* Learn More >
  • $0 copay for most preventive services, most immunizations, and lab services
  • Air medical transportation**
  • 24-Hour nurse hotline
Pie Chart with 90% filled

More than 90% of all Alabama physicians are in our network.

Pie Chart with 100% filled

Along with 100% of all Alabama hospitals!

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Blue Advantage

Complete (PPO)

$0 per month

View LIS Pricing >

Based on your income, you may qualify for financial help from Medicare to lower your monthly premium.* If you qualify, you will also have no drug coverage gap and lower out-of-pocket costs. If you aren't receiving extra help, the Alabama State Health Insurance Assistance Program (SHIP) provides education and counseling on low-income assistance programs for Medicare.

1-800-AGE-LINE (1-800-243-5463) TTY 1-800-548-2547

Medicare beneficiaries can qualify for Extra Help paying for their monthly premiums, annual deductibles, and co-payments related to Medicare prescription drug coverage. https://www.ssa.gov/benefits/medicare/prescriptionhelp

Plan Name No LIS 100%
Blue Advantage Complete (PPO)
0.00
0.00

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or your State Medicaid Office.

*You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

Blue Advantage

Premier (PPO)

$159 per month

View LIS Pricing >

Based on your income, you may qualify for financial help from Medicare to lower your monthly premium.* If you qualify, you will also have no drug coverage gap and lower out-of-pocket costs. If you aren't receiving extra help, the Alabama State Health Insurance Assistance Program (SHIP) provides education and counseling on low-income assistance programs for Medicare.

1-800-AGE-LINE (1-800-243-5463) TTY 1-800-548-2547

Medicare beneficiaries can qualify for Extra Help paying for their monthly premiums, annual deductibles, and co-payments related to Medicare prescription drug coverage. https://www.ssa.gov/benefits/medicare/prescriptionhelp

Plan Name No LIS 100%
Blue Advantage Premier (PPO)
159.00
117.60

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or your State Medicaid Office.

*You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

Primary Care Doctor Visit $5 copay per visit $5 copay per visit
Specialist Visit $35 copay per visit $20 copay per visit
Inpatient Hospital $290 copay per day for days 1–7;
You pay nothing per day for days 8-90;
$0 copay for days 91 and after
$175 copay per day for days 1–5;
You pay nothing per day for days 6-90;
$0 copay for days 91 and after
Outpatient Hospital Services $0-$245 copay $0-$150 copay
Lab Services $0 copay $0 copay
X-rays $15 copay $5 copay
Emergency Room Visit $120 copay
Waived if admitted
$120 copay
Waived if admitted
Ambulance $315 copay per trip $150 copay per trip
Many Preventive Wellness Services $0 copay $0 copay
Durable Medical Equipment 22% of cost 20% of cost
Telehealth Primary Care Physician $5 copay per visit $5 copay per visit
Telehealth Specialist $35 copay per visit $20 copay per visit
Diabetic Supplies* $0 copay $0 copay
Eye Exams $0 copay for annual routine exam & $30 copay for diagnostic exam $0 copay for annual routine exam & $25 copay for diagnostic exam
Eyewear Allowance $100 per calendar year $100 per calendar year
Preventive & Comprehensive Dental Allowance $1,000 max per calendar year $1,300 max per calendar year
Hearing Exams $0 copay for annual routine exam
$10 copay for diagnostic exam
$0 copay for annual routine exam
$10 copay for diagnostic exam
Hearing Aids $499/$699/$999 copay per hearing aid
(one per ear, per year)
$499/$699/$999 copay per hearing aid
(one per ear, per year)
Maximum Out-of-Pocket Amount
This is the most an individual will pay in a year for eligible health services. After paying this amount, your insurance policy will pay for all other covered services.
$5,100 (in-network) $3,400 (in-network)
PREFERRED Cost-Sharing Pharmacy Copays
A set fee you pay for a healthcare service, such as a visit to a doctor or hospital, or for a prescribed medication.
/ Coinsurance
The portion of the cost for healthcare that you will pay after you’ve met your deductible. For example, if you’ve met your deductible and your coinsurance is 20% and you receive a bill for $100, you’ll pay $20 and your insurance will pay the rest.
Tier 1 - Preferred Generic $4 $3
Tier 1 - Preferred Generic at Preferred
Mail-order Pharmacies
$0 $0
Tier 2 - Generic $13 $8
Tier 3 - Preferred Brand $40 $40
Tier 4 - Non-Preferred Drug 28% 29%
Tier 5 - Specialty Tier 33% 33%
Tier 6 - Select Care Tier $0 $0
Select Insulins (Tiers 3 & 4) $35 $35
STANDARD Cost-Sharing Pharmacy Copays
A set fee you pay for a healthcare service, such as a visit to a doctor or hospital, or for a prescribed medication.
/ Coinsurance
The portion of the cost for healthcare that you will pay after you’ve met your deductible. For example, if you’ve met your deductible and your coinsurance is 20% and you receive a bill for $100, you’ll pay $20 and your insurance will pay the rest.
Tier 1 - Preferred Generic $11 $10
Tier 2 - Generic $20 $15
Tier 3 - Preferred Brand $47 $47
Tier 4 - Non-Preferred Drug 33% 34%
Tier 5 - Specialty Tier 33% 33%
Tier 6 - Select Care Tier $0 $0
Select Insulins (Tiers 3 & 4) $35 $35
Coverage Gap Phase Once the TOTAL prescription annual spending exceeds $5,030 and YOUR spending is below $8,000 you pay 25% of generic drug costs and 25% of brand-name drug costs. The $0 copay for Tier 6, Select Care Drugs, and the $35 copay for covered insulins will continue through the Coverage Gap Phase. 

Once the TOTAL prescription annual spending exceeds $5,030 and YOUR spending is below $8,000 you pay 25% of generic drug costs and 25% of brand-name drug costs. The $0 copay for Tier 6, Select Care Drugs, and the $35 copay for covered insulins will continue through the Coverage Gap Phase. 

Catastrophic Coverage Phase Once YOUR out-of-pocket spending on prescriptions reaches $8,000, you pay $0 for the rest of the calendar year. Once YOUR out-of-pocket spending on prescriptions reaches $8,000, you pay $0 for the rest of the calendar year.

*Only Ascensia (Contour) and LifeScan (One-Touch) products are preferred with a $0 copay for up to 204 diabetic test strips for 30 days and glucometers at the pharmacy and through mail-order home delivery.

 

Insulin Disclaimer

Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you, even if you haven't paid your deductible. Call Member Services for more information. 
 
Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it's on.

Disclaimers SS and TH

*The Alabama FlexCard Mastercard® Prepaid card is issued by Stride Bank, N.A., Member FDIC, pursuant to license by Mastercard International.

**Air medical transport services are provided through a contract with AirMed International, LLC. AirMed International, LLC is an independent company that does not provide Blue Cross and Blue Shield of Alabama products. Blue Cross is not responsible for any mistakes, errors or omissions that AirMed, its employees or staff members make. Air medical services terminate if coverage by your health plan ends.

***All content ©2023 TruHearing, Inc. All Rights Reserved. TruHearing® and (Re)™ are registered trademarks of TruHearing, Inc. All other trademarks, product names, and company names are the property of their respective owners. Retail pricing based on prices for comparable aids. Follow-up provider visits included for one year following hearing aid purchase. Free battery offer is not applicable to the purchase of rechargeable hearing aid models. Three-year warranty includes repairs and one-time loss and damage replacement. Hearing aid repairs and replacements are subject to provider and manufacturer fees. For questions regarding fees, contact a TruHearing hearing consultant.

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