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Platinum Blue Choice Plan (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Platinum Blue Choice Plan (Cost). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Platinum Blue Choice Plan (Cost) in 2025, please refer to our full plan details page.
Platinum Blue Choice Plan (Cost) is a Cost plan offered by Aware Integrated, Inc. available for enrollment in 2025 to people living in 21 County Region. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Platinum Blue Choice Plan (Cost) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Platinum Blue Choice Plan (Cost).
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 Platinum Blue Choice Plan (Cost), 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Platinum Blue Choice Plan (Cost)
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Drug Coverage
Prescription drugs are not covered by Platinum Blue Choice Plan (Cost).
Additional Benefits
The Platinum Blue Choice Plan (Cost) offers a range of benefits, including inpatient hospital stays with a $200 copay per admission, outpatient services with varying copays, and ambulance services with a $100 copay. Emergency services have a $100 copay, and urgently needed services have a $15 copay. Primary care, preventive services, hearing, vision, dental, and home health services are covered, with specific copays, coinsurance, and annual limits. This plan also includes coverage for partial hospitalization with a $15 copay, home infusion services, dialysis with a $15 copay, and medical equipment with coinsurance. Additionally, acupuncture is covered with a $15 copay, and over-the-counter items are covered up to a $50 limit every three months. However, some services such as cardiac rehabilitation, additional hours of home health care, and certain dental, vision, and hearing services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For both, there is a $200 copay per admission or stay for Medicare-covered stays.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $50, Observation Services with a $50 copay, and Ambulatory Surgical Center (ASC) Services with a $50 copay. Outpatient Substance Abuse Services for individual and group sessions are not covered, and Outpatient Blood Services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Platinum Blue Choice Plan (Cost), with a $15 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Platinum Blue Choice Plan (Cost). Ground and Air Ambulance Services have a $100 copay, but 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 Services are covered by the Platinum Blue Choice Plan (Cost). Emergency Services have a $100 copay, Urgently Needed Services have a $15 copay, and Worldwide Emergency Coverage and Worldwide Emergency Transportation have a $100 copay, while Worldwide Urgent Coverage is not covered.
Primary Care See details
The Platinum Blue Choice Plan (Cost) covers Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services. Chiropractic Services, Physician Specialist Services, and Other Health Care Professional services each have a $15 copay. Individual and group sessions for Mental Health Specialty Services and Psychiatric Services, routine Chiropractic Care, Podiatry Services, and Additional Telehealth Benefits are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, annual physical exams, health education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. This plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, or counseling services. Fitness benefits and remote access technologies are covered.
Hearing Services See details
Hearing services are covered under the Platinum Blue Choice Plan (Cost), including routine hearing exams and fitting/evaluation for hearing aids with no deductible. Routine hearing exams are limited to 2 visits every year, and prescription hearing aids are covered with a copay between $599 and $899. Prescription hearing aids for the inner, outer, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
The Platinum Blue Choice Plan (Cost) covers vision services, including routine eye exams once per year. Eyewear is covered with a 20% coinsurance for contact lenses and a combined maximum benefit of $125 per year.
Dental Services See details
The Platinum Blue Choice Plan (Cost) covers Medicare dental services with a $15 copay, and other dental services up to a $2,000 annual maximum. The plan covers oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment, each with a limited number of visits per year, and adjunctive general services, while restorative services, endodontics, prosthodontics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a copay of $0-$35, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Platinum Blue Choice Plan (Cost), with a copay between $15.00 and $15.00. There is no coinsurance.
Medical Equipment See details
Medical Equipment is covered under the Platinum Blue Choice Plan (Cost), including Durable Medical Equipment with a 20-40% coinsurance, Prosthetics/Medical Supplies with no copay and a coinsurance for Medicare-covered items, and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Platinum Blue Choice Plan (Cost), with no copay. However, Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Platinum Blue Choice Plan (Cost) with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services are covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Therefore, this plan does not cover any cardiac rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Platinum Blue Choice Plan (Cost). There is no copay for days 1-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the Platinum Blue Choice Plan (Cost), acupuncture is covered with a $15 copay, up to 12 treatments per year, and over-the-counter (OTC) items are covered with a maximum benefit of $50 every three months. Other services, including meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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