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Blue adVantage Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue adVantage Premier (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue adVantage Premier (PPO) in 2025, please refer to our full plan details page.
Blue adVantage Premier (PPO) is a PPO plan offered by Louisiana Health Service & Indemnity Company available for enrollment in 2025 to people living in State of Louisiana. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Blue adVantage Premier (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Blue adVantage Premier (PPO).
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 adVantage Premier (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $143.00. 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 has a $1000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6200.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $6200.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page 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 adVantage Premier (PPO) plan has an enhanced alternative drug benefit. This plan has no deductible. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $12 copay at preferred pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Blue adVantage Premier (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services with varying copays, and no copays for many preventive services. The plan also covers emergency services, primary care visits with no copay for primary care physicians, and a range of hearing and vision services with no copays for routine exams and some eyewear. Dental services are also covered with no copays for many services, and home health services are covered with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered, with a copay of $170 per day for days 1-10, and no copay for days 11-90 for acute care. Inpatient psychiatric services have a copay of $205 for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered by the Blue adVantage Premier (PPO) plan. Outpatient Hospital Services have a copay between $0 and $200, Observation Services have a $170 copay, and Ambulatory Surgical Center Services have no copay. Individual and group sessions for outpatient substance abuse services have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue adVantage Premier (PPO) plan, with a $60 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue adVantage Premier (PPO) plan. Medicare-covered ground and air ambulance services have a $260 copay, and there is no coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Blue adVantage Premier (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay with no coinsurance, while Urgently Needed Services have a $35 copay with no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Blue adVantage Premier (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $40 copay, mental health specialty services with a $40 copay for individual and group sessions, other health care professional services with a copay between $0 and $40, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $40 copay. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams, and additional preventive services. Home-Based Palliative Care, Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include hearing exams with no copay, routine hearing exams with no copay for one exam per year, and fitting/evaluation for hearing aids with no copay for one exam per year. Prescription hearing aids have a maximum benefit of $1100 per year, and OTC hearing aids have no copay.
Vision Services See details
The Blue adVantage Premier (PPO) plan covers vision services, including eye exams with a $40 copay, routine eye exams with no copay, and eyewear with no copay. Eyewear has a combined maximum benefit of $400 per year for both in and out-of-network services. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay.
Dental Services See details
The Blue adVantage Premier (PPO) plan covers dental services, including oral exams, dental x-rays, and other diagnostic dental services, with no copay. The plan also covers fluoride treatments, prophylaxis, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery, all with no copay. However, maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue adVantage Premier (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Blue adVantage Premier (PPO) plan, with Durable Medical Equipment (DME) and Prosthetic Devices subject to 20% coinsurance and no copay. Some Diabetic Equipment and Durable Medical Equipment for use outside the home are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $30, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $140, Therapeutic Radiological Services with up to 20% coinsurance, and Outpatient X-Ray Services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Blue adVantage Premier (PPO) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Blue adVantage Premier (PPO) plan. Prior authorization is required for Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, but none of these services are covered by this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue adVantage Premier (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $165. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Blue adVantage Premier (PPO) plan's "Other Services" benefit covers Over-the-Counter (OTC) Items, but does not cover acupuncture, meal benefits, 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), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services.
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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.
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