A non-government entity
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 2026, 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 2026.
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 $160.00. 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 a $300.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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:
Sign up for Blue adVantage Premier (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Blue adVantage Premier (PPO) plan features a drug deductible of $300 and offers significant savings on generic medications. For Tier 1 preferred generics, you will pay no copay when using preferred pharmacies or preferred mail-order services, compared to a $10 copay for a one-month supply at standard locations. Tier 2 generic drugs cost $12 at preferred pharmacies and $18 at standard pharmacies for a one-month supply. For brand-name and specialty medications, Tier 3 preferred brands require a $45 copay at preferred locations and a $47 copay at standard locations for a one-month supply. Tier 4 non-preferred drugs are subject to a 50% coinsurance, while Tier 5 specialty drugs require a 29% coinsurance for a one-month supply across all pharmacy types. Choosing preferred pharmacies and mail-order services provides the lowest out-of-pocket costs under this plan.
Additional Benefits
The Blue adVantage Premier (PPO) plan offers robust medical coverage with predictable costs, including no copays or coinsurance for primary care visits, preventive care, and home health services. Specialist consultations, therapy sessions, and urgent care require low copays of $35 to $40, while emergency room visits carry a $125 copay. Inpatient hospital stays and skilled nursing facility care are covered with set daily copays for early days and no copays for extended stays. This PPO plan also features generous supplemental benefits, including dental coverage with no copay or coinsurance up to a $2,200 annual maximum. Routine vision and hearing exams, over-the-counter items, and routine eyewear up to $200 annually are also covered with no copay. Additionally, prescription hearing aids are covered up to $800 every three years, while durable medical equipment and dialysis services require a 20% coinsurance with no copay.
Inpatient Hospital See details
Blue adVantage Premier (PPO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization. Acute stays have a $170 daily copay for days 1 to 10 and no copay for days 11 to 90, while psychiatric stays have a $205 daily copay for days 1 to 7 and no copay for days 8 to 90; however, additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Blue adVantage Premier (PPO) covers outpatient services with no coinsurance, featuring a $0 to $200 copay for outpatient hospital services and a $170 daily copay for observation services. Ambulatory surgical and blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Blue adVantage Premier (PPO) plan with a $60.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Blue adVantage Premier (PPO) covers Medicare-covered ground and air ambulance services with a $260 copay and no coinsurance, which is not waived if you are admitted to the hospital. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Blue adVantage Premier (PPO) covers emergency services with a $125 copay and no coinsurance, which is waived if admitted to the hospital within 72 hours, and urgently needed services with a $35 copay and no coinsurance. Worldwide emergency services are partially covered, featuring worldwide emergency coverage with a $125 copay and no coinsurance, while worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Blue adVantage Premier (PPO) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, and mental health services require a $35 to $40 copay and no coinsurance. Other healthcare professionals require a 20% coinsurance and up to a $40 copay, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered by Blue adVantage Premier (PPO) with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome visit EKGs. The additional preventive services benefit is partially covered, providing only home-based palliative care and memory fitness, while health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are covered under the Blue adVantage Premier (PPO) with no copay and no coinsurance for routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with no copay or coinsurance up to an $800 maximum every three years, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Blue adVantage Premier (PPO), as other eye exam services are not covered. Routine eye exams and eyewear (up to a $200 annual limit) feature no copay and no coinsurance, while other covered eye exams require a $40 copay and no coinsurance.
Dental Services See details
Blue adVantage Premier (PPO) provides partially covered dental services with no copay and no coinsurance, up to a $2,200 annual maximum for both in-network and out-of-network care. Most preventive, diagnostic, restorative, and surgical services are covered, but other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue adVantage Premier (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Blue adVantage Premier (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Blue adVantage Premier (PPO) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Blue adVantage Premier (PPO) covers diagnostic tests and procedures with no coinsurance and a copay of up to $30, while lab services have no copay and no coinsurance. Prior authorization is required for radiological services, which feature no copay for diagnostic radiology, no copay with applicable coinsurance for outpatient X-rays, and a 20% coinsurance for therapeutic services.
Home Health Services See details
Blue adVantage Premier (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Blue adVantage Premier (PPO) with no copay or coinsurance, and prior authorization is required. While some services are covered, specific sub-services such as Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue adVantage Premier (PPO) with no coinsurance, though prior authorization and a prior three-day inpatient hospital stay are required. There is no copay for days 1 through 20, a $200 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Blue adVantage Premier (PPO), featuring Over-the-Counter (OTC) items with no copay and no coinsurance. Acupuncture, Meal Benefits, Nicotine Replacement Therapy, and Naloxone are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
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.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved