Overview
Deductible
This plan pays your Original Medicare Part A hospital deductible. You pay your Original Medicare Part B medical deductible.
Network
This plan doesn't have a network. You can see any doctor nationwide who accepts Original Medicare.
Out-of-pocket maximum
This plan doesn't have an out-of-pocket maximum.
Office visits
After you meet your Medicare Part B deductible, you may pay up to $20 per visit for services covered by Medicare.
Pharmacy
Plan features
• Pays almost all of your Medicare coinsurance and copays for medical services, hospice and skilled nursing facilities covered by Original Medicare.
• Pays 100% of your hospital costs for up to 365 days after you've used up your Medicare benefits.
• Includes discounts on products and services through Blue365®.
Plan discounts
Benefits
Deductible
This plan pays your Original Medicare Part A hospital deductible. You pay your Original Medicare Part B medical deductible.
Doctor and hospital choice
You can see any doctor nationwide who accepts Original Medicare.
Out-of-pocket maximum
No out-of-pocket maximum.
Preventive services
You pay $0 for most preventive services covered by Original Medicare. See the Medicare & You Handbook for details on all preventive services.
Doctor office visits
After you meet your Medicare Part B deductible, you may pay up to $20 per visit for services covered by Original Medicare.
Outpatient surgery
You may get outpatient surgery at a hospital, ambulatory facility or a doctor's office.
After you pay your Medicare Part B deductible, you pay $0 for services covered by Original Medicare.
Inpatient hospital care
You pay $0 for services covered by Original Medicare.
Blood
You pay $0 for the first three pints of blood you need each year.
Skilled nursing facility
You pay $0 for services covered by Original Medicare.
Hospice
You pay $0 for services covered by Original Medicare.
Urgent care
If your injury or illness doesn't require a visit to the emergency room and you can't get to your doctor's office, you can go to an urgent care facility.
After you meet your Medicare Part B deductible, you may pay up to $20 per visit for services covered by Original Medicare.
Emergency care
After you meet your Medicare Part B deductible, you'll pay $50 for an emergency room visit if you're not admitted. If you're admitted, you'll pay $0 for services covered by Original Medicare.
Ambulance services
After you meet your Medicare Part B deductible, you pay $0 for services covered by Original Medicare.
Durable medical equipment
After you meet your Medicare Part B deductible, you pay $0 for services covered by Original Medicare.
Chiropractic services
Original Medicare only covers chiropractic visits for manual manipulation of the spine to correct subluxation — a displacement or misalignment of a joint or body part.
After you meet your Medicare Part B deductible, you pay $0 for services covered by Original Medicare. Office visit copay may apply.
Podiatry services
Original Medicare covers medically necessary foot care.
After you meet your Medicare Part B deductible, you pay $0 for services covered by Original Medicare. Office visit copay may apply.
Outpatient mental health services
Original Medicare covers:
• Individual therapy visits
• Group therapy visits
• Individual therapy visits with a psychiatrist
• Group therapy visits with a psychiatrist
After you meet your Medicare Part B deductible, you pay $0 for services covered by Original Medicare. Office visit copay may apply.
Occupational, physical and speech therapy
After you meet your Medicare Part B deductible, you pay $0 for services covered by Original Medicare. Office visit copay may apply.
Renal dialysis
After you meet this plan's deductible, you pay $0 for services covered by Original Medicare.
Emergency care outside the U.S.
You pay a $250 deductible and 20% of the costs of services. Lifetime maximum of $50,000.
Forms and Documents
Learn more about this plan
Outline of Coverage (PDF)
Use this document to:
• Learn more about A, C, D, F, HD-F, G, HD-G, and N
• See the prices for each plan
• Apply if you're ready
Medicare Plus BlueSM PPO Essential
