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Platinum Blue Core Plan with Rx (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Platinum Blue Core Plan with Rx (Cost). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Platinum Blue Core Plan with Rx (Cost) in 2025, please refer to our full plan details page.
Platinum Blue Core Plan with Rx (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 Core Plan with Rx (Cost) 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 Platinum Blue Core Plan with Rx (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 Core Plan with Rx (Cost), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $60.40. 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.
This plan has a $590.00 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 Maximum Out-Of-Pocket cost of $6000.00 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:
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Drug Coverage
The Platinum Blue Core Plan with Rx (Cost) has a deductible of $590. After your deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, in the initial coverage phase, you'll pay a $5 copay for preferred generic drugs at a standard or mail-order pharmacy. Standard generic drugs have a 25% coinsurance, and preferred brand drugs have a 44% coinsurance at a standard pharmacy. After your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Platinum Blue Core Plan with Rx (Cost) offers a variety of additional benefits beyond standard Medicare coverage. This plan includes coverage for inpatient hospital stays with a $600 copay per admission, outpatient services with some services having a copay, ambulance services with 20% coinsurance, and emergency services with a $125 copay. This plan also covers hearing exams and hearing aids with a copay between $699 and $999 per year, vision services with 20% coinsurance for eyewear, and dental services with a 20% coinsurance for Medicare dental services.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a $600 copay per admission or stay. Additional days, and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered, and upgrades for Inpatient Hospital-Acute are also not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient substance abuse individual and group sessions have a $20 copay. Outpatient blood services include a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the Platinum Blue Core Plan with Rx (Cost), with a $60 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Platinum Blue Core Plan with Rx (Cost). Ground and Air Ambulance Services have a 20% coinsurance, and there is no copay for ambulance services. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Platinum Blue Core Plan with Rx (Cost) with a $125 copay, and Urgently Needed Services are covered with a $55 copay. Worldwide Emergency Coverage has a $125 copay, and Worldwide Emergency Transportation has a 20% coinsurance, while Worldwide Urgent Coverage is not covered.
Primary Care See details
The Platinum Blue Core Plan with Rx (Cost) covers primary care physician services and chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with 20% coinsurance, mental health specialty services with a $20 copay for individual and group sessions, physical therapy and speech-language pathology services with a $40 copay, and opioid treatment program services with 20% coinsurance. Routine chiropractic care, podiatry services, and additional telehealth benefits are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, an annual physical exam, and additional preventive services are covered. Health education, fitness benefits, remote access technologies, kidney disease education services, and other preventive services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered. 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, and counseling services are not covered.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered. Prescription hearing aids (all types) are covered with a copay between $699 and $999 per year, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by the Platinum Blue Core Plan with Rx (Cost), but routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered. Eyewear has a 20% coinsurance, and there is no deductible for eyewear.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services, but Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a copay between $0 and $35. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Platinum Blue Core Plan with Rx (Cost). You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment with 20% to 40% coinsurance and no copay, and Prosthetic Devices and Medical Supplies with 20% coinsurance and no copay. Diabetic Equipment is covered, with a coinsurance for Medicare-covered Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts with 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, with a $25 copay for Diagnostic Procedures/Tests and a maximum 20% coinsurance for Diagnostic and Therapeutic Radiological Services. Outpatient X-Ray Services have a $60 copay, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Platinum Blue Core Plan with Rx (Cost) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Platinum Blue Core Plan with Rx (Cost). This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Platinum Blue Core Plan with Rx (Cost). There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Platinum Blue Core Plan with Rx (Cost) covers acupuncture with a $20 copay, and up to 12 treatments per year. Over-the-counter items are covered with a $25 maximum benefit every three months, and the plan offers nicotine replacement therapy as an OTC benefit. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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