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Blue Medicare Advantage (Medicare-Medicaid Plan)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Medicare Advantage (Medicare-Medicaid Plan). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Medicare Advantage (Medicare-Medicaid Plan) in 2025, please refer to our full plan details page.
Blue Medicare Advantage (Medicare-Medicaid Plan) is a Medicare-Medicaid Plan plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in State of IL. The overall rating for this plan is not yet available for 2025.
It's important to know that Blue Medicare Advantage (Medicare-Medicaid Plan) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Blue Medicare Advantage (Medicare-Medicaid Plan)is a Medicare-Medicaide (MMP) plan. This means you can only enroll in this plan if you meet specific criteria for both medicare and medicaid. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Blue Medicare Advantage (Medicare-Medicaid Plan).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Blue Medicare Advantage (Medicare-Medicaid Plan), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
We don't have information on the Maximum Out-Of-Pocket cost for this plan. You can call our licensed insurance specialists by clicking "Call to Enroll" below for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Blue Medicare Advantage (Medicare-Medicaid Plan) has an enhanced alternative drug benefit. The plan has a $0 deductible for prescription drugs. During the initial coverage phase, you pay the costs for your drugs until the total drug costs reach $2000. Once you reach that amount, you enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Blue Medicare Advantage plan offers a wide range of benefits with a focus on outpatient and preventive care. Many services, including primary care, emergency services, and home health services, have no copay. The plan also includes coverage for hearing, vision, and dental services, as well as medical equipment and home infusion services. While many services come with no copay, some services require prior authorization or have other limitations. Additionally, certain services, such as some outpatient services, and non-Medicare-covered stays, may involve cost-sharing. Be sure to review the plan details to understand all the specific coverage and cost-sharing details.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, as well as additional days and non-Medicare-covered stays, but upgrades are not covered. The plan does not specify the copay or coinsurance for these services.
Outpatient Services See details
Outpatient Services are covered under the Blue Medicare Advantage (Medicare-Medicaid Plan), including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services. Outpatient Substance Abuse Services are partially covered; individual and group sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Medicare Advantage (Medicare-Medicaid Plan), but requires prior authorization. The plan does not specify any cost information such as copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay or coinsurance for all ambulance services. Transportation Services to a plan-approved health-related location are covered, but ground and air ambulance services, as well as transportation services to any health-related location, are not covered.
Emergency Services See details
Emergency Services are covered under the Blue Medicare Advantage (Medicare-Medicaid Plan), including Emergency Services and Urgently Needed Services, with no copay and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Blue Medicare Advantage plan covers primary care physician services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services with no copay and no coinsurance. Chiropractic services are partially covered, with routine chiropractic care not covered, and podiatry services, individual and group sessions for mental health specialty services, and individual and group sessions for psychiatric services are not covered.
Preventive Services See details
Preventive services, including Medicare-covered services, are covered by the plan, but the annual physical exam is not covered. Additional preventive services, such as fitness benefits, are covered.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids with no copay, as well as prescription hearing aids, including all types, every three years. Prescription hearing aids require prior authorization, and inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams, other eye exam services, eyewear, and upgrades. Routine eye exams are covered once per year, and other eye exam services are covered as medically necessary. Contact lenses are covered as medically necessary, while eyeglasses (lenses and frames) are covered once every two years, and eyeglass frames are not covered.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery. However, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Blue Medicare Advantage (Medicare-Medicaid Plan), including Medicare Part B Insulin Drugs. The plan does not cover Medicare Part B Chemotherapy/Radiation Drugs.
Dialysis Services See details
Dialysis Services are covered with prior authorization required. There is no information about the cost of services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, both with no copay or coinsurance. However, Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but the plan does not cover diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, or outpatient X-ray services. There is no copay for these services.
Home Health Services See details
Home Health Services are covered by the Blue Medicare Advantage (Medicare-Medicaid Plan) with no copay or coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, including additional days beyond Medicare-covered and non-Medicare-covered stays. Non-Medicare-covered stays have a coinsurance and copay, and prior authorization is required for SNF services.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items, Meal Benefit, Institution for Mental Disease Services for Individuals 65 or Older, Other 1 (Hospice), Other 2 (Behavioral Health), Other 3 (Telehealth), Other 4 (Emergency Dental), Other 5 (Cell Phone Benefit), Other 7 (Medication Assisted Treatment (MAT)), Other 8 (Crisis Services (Expanded)), Other 9 (Gender-Affirming Services), Tobacco Cessation Counseling for Pregnant Women, and Nursing Home Services. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
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