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Blue adVantage Thrive (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue adVantage Thrive (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue adVantage Thrive (PPO) in 2026, please refer to our full plan details page.
Blue adVantage Thrive (PPO) is a PPO plan offered by Louisiana Health Service & Indemnity Company available for enrollment in 2026 to people living in North and Central. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Blue adVantage Thrive (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 Thrive (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 Thrive (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.
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 $10100.00 (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 $10100.00 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 Thrive (PPO) plan features a $300 drug deductible. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service, while standard pharmacies charge a $10 copay for a one-month supply. Tier 2 generic drugs cost $12 for a one-month supply at preferred locations and $18 at standard locations. For Tier 3 preferred brand drugs, a one-month supply costs a $45 copay at preferred pharmacies and $47 at standard pharmacies. Tier 4 non-preferred drugs require a 50% coinsurance for all supply lengths, while Tier 5 specialty drugs carry a 29% coinsurance for a one-month supply across all pharmacy types.
Additional Benefits
The Blue adVantage Thrive (PPO) plan provides affordable medical coverage with no copay and no coinsurance for primary care visits, home health services, and routine preventive care. Specialist visits require a predictable $35 copay, while inpatient hospital stays feature a $225 daily copay for the first seven days and no copay for days eight through 90. Emergency services are covered with a $110 copay, which is waived if you are admitted to the hospital within 72 hours. This plan also features generous supplemental benefits, including up to $2,200 in annual dental coverage and a $200 annual limit for eyewear with no copay or coinsurance. Routine hearing exams and over-the-counter hearing aids are fully covered with no copay, plus the plan offers up to $800 every three years for prescription hearing aids. For other medical needs, durable medical equipment and dialysis services are covered with no copay and a 20 percent coinsurance.
Inpatient Hospital See details
Blue adVantage Thrive (PPO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, featuring a $225 daily copay for days 1 through 7 and no copay for days 8 through 90. Prior authorization is required, and the plan does not cover additional hospital days, upgrades, or non-Medicare-covered stays.
Outpatient Services See details
Outpatient services are covered by Blue adVantage Thrive (PPO) with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services, a $225 daily copay for observation services, and a $40 copay for substance abuse sessions. Additionally, there are no copays and no coinsurance for ambulatory surgical center services and outpatient blood services.
Partial Hospitalization See details
Blue adVantage Thrive (PPO) covers partial hospitalization with a $60.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Blue adVantage Thrive (PPO) partially covers ambulance and transportation services, providing ground and air ambulance coverage with a $300 copay and no coinsurance. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Blue adVantage Thrive (PPO) covers emergency services with a $110 copay, which is waived if admitted to the hospital within 72 hours, and no coinsurance, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency services are partially covered with a $110 copay and no coinsurance, but worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Blue adVantage Thrive (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $35 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services have a $40 copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Blue adVantage Thrive (PPO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, but health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, home safety devices, and counseling are not covered.
Hearing Services See details
Blue adVantage Thrive (PPO) hearing services are covered with no copay and no coinsurance for routine exams, fitting evaluations, and OTC hearing aids. For prescription hearing aids, some services are covered with no copay or coinsurance up to an $800 limit every three years, though inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Blue adVantage Thrive (PPO) partially covers vision services, featuring eye exams with a $35 copay and no coinsurance, though routine yearly exams have no copay and other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $200 combined annual limit for contacts, lenses, frames, and upgrades.
Dental Services See details
Blue adVantage Thrive (PPO) covers dental services with no copay and no coinsurance up to an annual maximum benefit of $2,200 for both in-network and out-of-network care. This benefit is partially covered, as other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue adVantage Thrive (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Blue adVantage Thrive (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Blue adVantage Thrive (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. While diabetic equipment is covered with no copay and no coinsurance, diabetic supplies and diabetic therapeutic shoes or inserts are not covered under this plan.
Diagnostic and Radiological Services See details
Blue adVantage Thrive (PPO) covers diagnostic and radiological services, with prior authorization required. Diagnostic services feature no coinsurance, offering lab services with no copay and diagnostic procedures with a $0 to $30 copay, while radiological services include outpatient X-rays with no copay and therapeutic services with a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Blue adVantage Thrive (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Blue adVantage Thrive (PPO) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered in practice and require copays of $15 to $20.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue adVantage Thrive (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, followed by a $200 daily copay for days 21 through 100, with no coverage provided for additional days.
Other Services See details
Blue adVantage Thrive (PPO) partially covers Other Services, offering Over-the-Counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and dual-eligible SNPs are not covered under this benefit.
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