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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 and starting at $1,000 allowance for preventative and comprehensive dental per calendar year
  • FREE SilverSneakers® fitness membership
  • $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 STANDARD and PREFERRED pharmacy networks include CVS, Publix, Walgreens, Walmart plus HUNDREDS of local independent neighborhood pharmacies!

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Comprehensive & Preventive Dental

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Comprehensive & Preventive Dental

 

Our Dental plans are designed to deliver care at an affordable price with no waiting period for Comprehensive and Preventive Services.

$1,000/$1,200 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 $699 or $999 (one per ear, per year) which can save you thousands of dollars.

*All content ©2021 TruHearing, Inc. All rights reserved. TruHearing® is a registered trademark of TruHearing, Inc. All appointments must be performed by a TruHearing network provider.

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Silver Sneakers® Membership

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Enjoy a complimentary SilverSneakers® fitness membership!

 

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

  • Unlimited gym access at over 300 participating locations in Alabama
  • At-home kits available if you can't get to a fitness location due to health reasons
  • Online resources and support from trained Advisors

*SilverSneakers is a registered trademark of Tivity Health, Inc. © 2021 Tivity Health, Inc. All rights reserved.

Blue Advantage makes it easy to stay healthy and save money

  • 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 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 SilverSneakers® fitness membership* 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

Plan Name No LIS 25% 50% 75% 100%
Blue Advantage Complete (PPO)
0.00
0.00
0.00
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)

$171 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

Plan Name No LIS 25% 50% 75% 100%
Blue Advantage Premier (PPO)
171.00
162.80
154.60
146.50
138.30

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 $40 copay per visit $25 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-$250 copay $0-$150 copay
Lab Services $0 copay $0 copay
X-rays $15 copay $5 copay
Emergency Room Visit $90 copay
Waived if admitted
$120 copay
Waived if admitted
Ambulance $275 copay per trip $150 copay per trip
Many Preventive Wellness Services $0 copay $0 copay
Durable Medical Equipment 20% of cost 20% of cost
Telehealth Primary Care Physician $5 copay per visit $5 copay per visit
Telehealth Specialist $40 copay per visit $25 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 $1,200 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 $699/$999 copay per hearing aid
(one per ear, per year)
$699/$999 copay per hearing aid
(one per ear, per year)
Maximum Out-of-Pocket Amount $5,100 (in-network) $3,400 (in-network)
PREFERRED Cost-Sharing Pharmacy Copays/Coinsurance
Tier 1 - Preferred Generic $4 $3
Tier 2 - Generic $13 $8
Tier 3 - Preferred Brand $40 $40
Tier 4 - Non-Preferred Brand 32% 42%
Tier 5 - Specialty Tier 30% 33%
Tier 6 - Select Care Tier $0 copay $0 copay
STANDARD Cost-Sharing Pharmacy Copays / Coinsurance
Tier 1 - Preferred Generic $11 $10
Tier 2 - Generic $20 $15
Tier 3 - Preferred Brand $47 $47
Tier 4 - Non-Preferred Brand 37% 47%
Tier 5 - Specialty Tier 30% 33%
Tier 6 - Select Care Tier $0 copay $0 copay
Coverage Gap Phase Once the TOTAL prescription annual spending exceeds $4,430 and YOUR spending is below $7,050 you pay 25% of generic drug costs and 25% of brand-name drug costs. Once the TOTAL prescription annual spending exceeds $4,430 and YOUR spending is below $7,050 you pay 25% of generic drug costs and 25% of brand-name drug costs.
Catastrophic Coverage Phase Once YOUR out-of-pocket spending on prescriptions reaches $7,050 you pay the greater of $3.95 for generic drugs and $9.85 for brand-name drugs OR 5% coinsurance per prescription for the rest of the year. Blue Advantage pays the rest. Once YOUR out-of-pocket spending on prescriptions reaches $7,050 you pay the greater of $3.95 for generic drugs and $9.85 for brand-name drugs OR 5% coinsurance per prescription for the rest of the year. Blue Advantage pays the rest.

*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.

 

Disclaimers SS and TH

*SilverSneakers is a registered trademark of Tivity Health, Inc. © 2021 Tivity Health, Inc. All rights reserved.

** 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 ©2021 TruHearing, Inc. All Rights Reserved. TruHearing® is a registered trademark 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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