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Blue adVantage Liberty (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue adVantage Liberty (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue adVantage Liberty (PPO) in 2025, please refer to our full plan details page.
Blue adVantage Liberty (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 Liberty (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 Liberty (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 Liberty (PPO), 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. Additionally, this plan comes with a Part B Premium reduction of $0.50. You must continue to pay paying your reduced 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 $195.00 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 $11300.00 (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 $11300.00 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 Liberty (PPO) plan has a $195.00 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For generic drugs, you can expect to pay a copay, such as $12.00 or $18.00 depending on the pharmacy. For preferred brand drugs, you will pay 50% coinsurance, and for non-preferred drugs, you will pay 29% coinsurance. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Blue adVantage Liberty (PPO) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services have copays that vary by service. Emergency services have a copay, and primary care physician services are available with no copay. Preventive services and hearing exams are covered with no copay, and vision services include eye exams and eyewear benefits. Dental services are covered with a maximum annual benefit. The plan also includes coverage for home infusion, dialysis, and durable medical equipment with coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $320 for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute, and a copay of $290 for days 1-7 and no copay for days 8-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $300, observation services with a $320 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services, including individual and group sessions, have a $40 copay, while outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue adVantage Liberty (PPO) plan, but requires prior authorization. The copay for this benefit is $60.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue adVantage Liberty (PPO) plan, but require prior authorization. Ground and air ambulance services have a $300 copay, with no coinsurance. 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 by the Blue adVantage Liberty (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, and Urgently Needed Services have a $45 copay, and there is no coinsurance for any of these services. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay. Chiropractic Services have a $15 copay, but routine care is not covered. Occupational Therapy Services have a $35 copay. Physician Specialist Services have a $50 copay. Mental Health Specialty Services, including individual and group sessions, have a $40 copay. Other Health Care Professional services have a 20% coinsurance and a copay between $0 and $50. Psychiatric Services, including individual and group sessions, have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a $35 copay. Additional Telehealth Benefits have a copay between $0 and $50. Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
The Blue adVantage Liberty (PPO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, kidney disease education services, and other preventive services with no copay. Some additional preventive services, such as health education, in-home safety assessments, and weight management programs, are not covered.
Hearing Services See details
The Blue adVantage Liberty (PPO) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $1,000 per year, with no copay. OTC hearing aids are covered with no copay.
Vision Services See details
The Blue adVantage Liberty (PPO) plan covers vision services, including eye exams with a $50 copay. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. Eyewear has a combined maximum benefit of $400 per year, applicable to both in-network and out-of-network services.
Dental Services See details
Dental Services are covered, with a $2,200 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery have no copay. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Blue adVantage Liberty (PPO) plan, including Medicare Part B Insulin Drugs for a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Blue adVantage Liberty (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Additionally, all covered services require prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Blue adVantage Liberty (PPO) plan, with a $0-$30 copay for Diagnostic Procedures/Tests and no copay for Lab Services. Diagnostic Radiological Services have a copay of up to $290, while Therapeutic Radiological Services have a minimum coinsurance of 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Blue adVantage Liberty (PPO) plan with no copay and no 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 Liberty (PPO) plan. Prior authorization is required for the services, but there is no information provided about the cost for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue adVantage Liberty (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $165.
Other Services See details
Other Services includes coverage for over-the-counter (OTC) items, but does not cover acupuncture, meal benefits, or dual eligible SNPs with highly integrated services. Additionally, many other services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and more.
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