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Medicare Advantage (Part C) plans PPO and HMO
Let’s go beyond health insurance to give you what you really deserve: health solutions. See how Florida Blue Medicare Advantage plans are solving for your health care needs and budget.
plans with $0 monthly premiums
all the benefits of Original Medicare (Parts A and B)
most plans include Part D prescription drug coverage
extra dental, hearing, and vision benefits
earn reward dollars4 when you complete certain preventive screenings and health activities between January 1 and December 31
low or no copay to see a primary care doctor
SilverSneakers®2 Fitness program
comprehensive network of providers
personalized service and expert guidance
Choose the right Medicare Advantage plan
You have options when it comes to Medicare Advantage (Part C) plans. Many of our Medicare Advantage plans can give you vision, dental, and hearing coverage, and low or no copays to see doctors and specialists. Most plans even have a $0monthly plan premium.
Part C PPO plans
Do you want the freedom to choose any doctor who accepts Medicare and a network of lower cost providers when you travel? If you don't like to wait for a primary care doctor referral to go to a specialist, one of our Medicare Advantage PPO plans may be better for you.
• Choose any doctor who accepts Medicare.
• Save with lower out-of-pocket costs when you use in-network providers
• Have the option to use health care providers out-of-network
• See a specialist visits without needing a referral
• Earn reward dollars4 when you complete certain preventive screenings and health activities betweenJanuary 1 and December 31
Part C HMO plans
Like to save money? Prefer having one doctor to coordinate your care with specialists and other health care providers? Then one of our Medicare Advantage HMO plans could be a great choice for you.
• You choose a trusted primary care physician to coordinate your medical needs
• With most plans, you need to use in-network doctors, specialists, or hospitals, with a few exceptions, like medical emergencies
• You can benefit from our rewards program4
Part C HMO DSNP: Medicare and Medicaid benefits
Our HMO DSNP plans coverthose who have both Medicare and Medicaid.These plans have extra benefits for members that qualify.
• Support services to help you schedule appointments, provide transportation, or explain your benefits
• Over-the-counter (OTC) Allowance to use towardthe purchase of eligible OTC items
• Healthy Food Allowance* is a monthly allowance added to your Blue Dollars Benefits Mastercard®Prepaid Card, for use towardthe purchase of healthy foods
• Post-discharge meals delivered to your home based on your nutritional needs1
• $0 prescription copays on all Part D covered prescription costsfor both generics and brand name for members with Low Income Subsidy (LIS) / Extra Help*
What does a Medicare Advantage plan cost?
Like Original Medicare, Medicare Advantage (Part C) plans share the cost of care through deductibles, copayments (copays), and coinsurance. These costs vary by plan.
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Deductible– The amount you pay before Florida Blue Medicare begins to pay its share of the cost. Some Medicare Advantage plans have a separate drug deductible before they start to pay for your prescriptions.
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Copay –A flat dollar amount (for example, $10) you pay each time you receive care or fill a prescription
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Coinsurance– A percentage (for example, 10%) you pay for your care or prescription drugs after you meet your deductible
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Premium– A fixed, monthly amount you pay for your Medicare Advantage plan coverage. Many Florida Blue Part C plans have a $0 premium.
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Out-of-pocket maximum– The most you pay for covered health care services during your plan’s calendar year. All of your Medicare-covered expenses go toward this maximum.
Compare Medicare Advantage plan benefits and features
| HMO | HMO DSNP | PPO | |
|---|---|---|---|
Monthly plan premiums | $0 | $0 to $37.703 | in select plans |
Medical deductible | (not available) | (not available) | in select plans |
Limited out-of-pocket costs for care each year | |||
Hospital, ER, andurgent care coverage | |||
Preventive care | |||
Non-emergency/non-urgent coverage outside of Florida | (not available) | (not available) | |
Dental coverage | in select plans | ||
Vision, hearing, andprescription drug (Rx) coverage | in select plans | ||
Mental health and substance abuse services | |||
Skilled nursing facility and home health agency coverage | |||
Able to see specialists without a referral and not have a primary care physician | (not available) | (not available) | |
Able to see providers out-of-network | (not available) | (not available) | |
Rx mail-order benefit | |||
Over-the-counter (OTC) medication allowance | in select plans | in select plans | |
Transportation benefit | in select plans | (not available) | |
Post discharge meals1 | (not available) | (not available) | |
Meals-at-home program | in select plans | (not available) | |
Healthy Food Allowance*+ | in select plans | (not available) | |
Fitness benefit – SilverSneakers®2 | |||
Member Rewards program4 | |||
Online member portal |
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Disclaimers:
Post discharge meals:
1Available to HMO DSNP plan members following a hospital discharge.
SilverSneakers®:
2SilverSneakers® is a registered trademark of Tivity Health, Inc. © 2024 Tivity Health, Inc. All rights reserved.
$0 Monthly Plan Premiums:
3Monthly plan premium is $0 for individuals with Medicaid, QMB, or SLMB. Individuals with QI or QWDI qualify for the plan and may have a premium up to $37.70. Sponsored by Florida Blue Medicare, Inc., d/b/a Florida Blue Medicare, and the State of Florida, Agency for Health Care Administration.
HealthyBlue Rewards:
4HealthyBlue Rewards Program (HealthyBlue) restrictions and limitations may apply. Eligible members who opt in to participate in HealthyBlue Rewards must complete the activity and redeem rewards no later than December 31 of the benefit year. Unredeemed rewards earned in 2024 will not carry over to 2025 and will expire if you disenroll from the plan. Participation in HealthyBlue is voluntary and offered at no additional cost to you.
Blue Dollars card:
Allowance amounts vary by plan. Any unused amounts do not rollover to the next period. Consult the Evidence of Coverage for details. Eligible allowance and rewards amounts cannot be combined. Additional limitations or restrictions may apply. Subscription-type services like Walmart+, Instacart, Shipt, and Amazon are not eligible. The Benefits Mastercard® Prepaid Card, is issued by The Bancorp Bank, N.A., Member FDIC, pursuant to license by Mastercard® International Incorporated. Mastercard® and the circles design are registered trademarks of Mastercard® International Incorporated. Card can be used for eligible expenses wherever Mastercard is accepted. Valid only in the U.S. No cash access.
Special Supplemental Benefits for the Chronically Ill (SSBCI):
+Non-DSNP Plans: This benefit is part of special supplemental benefits and not all members will qualify. See Special Supplemental Benefits for the Chronically Ill (SSBCI) in your Plan’s Evidence of Coverage for full eligibility requirements.
VBID (Value-Based Insurance Design) Benefits: Healthy Food Allowance and $0 Rx Copay:
*Dual Eligible Special Needs (DSNP) Plans: Eligibility for the monthly healthy food allowance and $0 copays for Part D covered drugs will be determined at the time of enrollment, based on LIS also known as “Extra Help”. Unused monthly food allowance does not roll over to the next month.
FBM PRODUCT NF
Disclaimers
Last Updated: 10.01.2023
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