A non-government entity
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 2026, 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 3.5 out of 5 stars in 2026.
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 $48.90. 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 $615.00 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:
Sign up for Platinum Blue Core Plan with Rx (Cost)
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 Platinum Blue Core Plan with Rx (Cost) features an annual prescription drug deductible of $615. During the initial coverage phase, Tier 1 preferred generic drugs cost as little as a $5 copay for a one-month supply at standard pharmacies and preferred mail-order services. Tier 2 generic drugs are also highly affordable, requiring a $15 copay for a one-month supply at standard pharmacies or through preferred mail-order. For higher-tier medications, the plan transitions to coinsurance, with Tier 3 preferred brand drugs and Tier 5 specialty drugs requiring a 25% coinsurance. Tier 4 non-preferred drugs carry a 44% coinsurance at standard pharmacies and preferred mail-order, which increases to 46% for standard mail-order. Utilizing standard pharmacies or preferred mail-order services generally offers the most cost-effective copayments and coinsurance rates under this plan.
Additional Benefits
The Platinum Blue Core Plan with Rx (Cost) offers robust coverage for essential medical services with manageable out-of-pocket costs. Inpatient hospital stays require a $300 daily copay for the first five days and no copay thereafter, while emergency room visits carry a $130 copay that is waived if you are admitted. For routine care, doctor visits are highly affordable, requiring only a $20 copay for primary care and a $45 copay for specialists with no coinsurance. Preventive services, home health care, and routine hearing exams are fully covered with no copay and no coinsurance. Other specialized services like outpatient hospital care, diagnostics, and medical equipment are covered with low copays or standard 20% coinsurance. Additionally, the plan provides valuable coverage for Medicare-approved dental services and prescription hearing aids to help you manage your overall health.
Inpatient Hospital See details
Platinum Blue Core Plan with Rx (Cost) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $300 daily copayment for days 1 through 5 and no copayment for days 6 through 90. Additional hospital days, non-Medicare-covered stays, and room upgrades are not covered under this benefit.
Outpatient Services See details
Platinum Blue Core Plan with Rx (Cost) covers outpatient services, offering outpatient hospital and ambulatory surgical center services with no copay and a 20% coinsurance. Outpatient substance abuse services require a $20 copay for individual or group sessions with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by the Platinum Blue Core Plan with Rx (Cost) with a $60.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Platinum Blue Core Plan with Rx (Cost) covers ground and air ambulance services with a 20% coinsurance and no copay, which is not waived upon hospital admission. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by the Platinum Blue Core Plan with Rx (Cost) with a $130 copay and no coinsurance (waived if admitted within 24 hours), while urgent care requires a $50 copay and no coinsurance. Worldwide emergency services are partially covered, featuring a $130 copay and no coinsurance for emergency care and a 20% coinsurance with no copay for transportation, though worldwide urgent care is not covered. These cost-sharing amounts do not count toward any plan-level deductible.
Primary Care See details
Platinum Blue Core Plan with Rx (Cost) covers primary care visits for a $20 copay, specialist visits for a $45 copay, and therapy services for a $40 copay, all with no coinsurance. Mental health sessions require a $20 copay with no coinsurance, and opioid treatment has no copay with 20% coinsurance, while chiropractic, podiatry, and telehealth services are not covered.
Preventive Services See details
Preventive Services are partially covered by the Platinum Blue Core Plan with Rx (Cost) with no copay and no coinsurance for covered care like annual physicals and kidney disease education. However, the plan does not cover in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety modifications, or counseling.
Hearing Services See details
Hearing Services are partially covered under the Platinum Blue Core Plan with Rx (Cost), offering routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a $699 to $999 copay for up to two devices per year, though OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered under the Platinum Blue Core Plan with Rx (Cost) with no deductible, no copay, and no coinsurance for eye exams, and no copay with a 20% coinsurance for eyewear. While some services are covered, routine eye exams, contact lenses, and eyeglasses are not covered.
Dental Services See details
Platinum Blue Core Plan with Rx (Cost) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance, though prior authorization is required. Non-Medicare dental services, including oral exams, cleanings, x-rays, fluoride treatments, restorative services, and endodontics, are not covered.
Home Infusion bundled Services See details
Platinum Blue Core Plan with Rx (Cost) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs require a $0 to $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Platinum Blue Core Plan with Rx (Cost) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered under the Platinum Blue Core Plan with Rx (Cost) with no copay, though diabetic supplies are not covered. Covered durable medical equipment carries a 20% to 40% coinsurance and requires prior authorization, while prosthetic devices, medical supplies, and diabetic therapeutic shoes require a 20% coinsurance.
Diagnostic and Radiological Services See details
Platinum Blue Core Plan with Rx (Cost) partially covers diagnostic and radiological services, as laboratory services are not covered. Diagnostic procedures and tests have no coinsurance and a copay ranging from no copay to $25, while radiological services require a $60 copay for X-rays, 20% coinsurance for therapeutic radiology, and a copay with no coinsurance for diagnostic radiology.
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.
Cardiac Rehabilitation Services See details
Platinum Blue Core Plan with Rx (Cost) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, but cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Platinum Blue Core Plan with Rx (Cost) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. A prior 3-day inpatient hospital stay is required before admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Platinum Blue Core Plan with Rx (Cost) provides partially covered other services, including acupuncture for a $15 copay and no coinsurance, and over-the-counter items with no copay and no coinsurance up to $25 every three months. Additional telehealth is covered with a $0 to $50 copay and 20% coinsurance, while meal benefits are not covered.
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