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Platinum Blue Choice Plan with Rx (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Platinum Blue Choice 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 Choice Plan with Rx (Cost) in 2025, please refer to our full plan details page.
Platinum Blue Choice 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 Choice 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 Choice 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 Choice Plan with Rx (Cost), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $176.20. 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 $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:
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Drug Coverage
The Platinum Blue Choice Plan with Rx (Cost) has a $590 deductible for prescription drugs. Once you meet the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you will pay a $10 copay for preferred generic drugs at a standard pharmacy, and 24% coinsurance for standard generic drugs at a standard pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Platinum Blue Choice Plan with Rx (Cost) offers comprehensive coverage for several services, including inpatient hospital stays with a $200 copay, outpatient services with copays ranging from $0 to $50, and ambulance services with a $100 copay. Additionally, the plan includes coverage for primary care, preventive services, hearing, vision, and dental care, each with specific copays, coinsurance, and annual maximums. This plan also provides coverage for dialysis services with a $15 copay, home health services with no copay, and skilled nursing facility (SNF) services with no copay for a limited time. Furthermore, the plan includes coverage for medical equipment, diagnostic services, and other services like acupuncture and over-the-counter items. However, it's important to note that certain services, such as outpatient substance abuse, are only partially covered, and many other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits for the Platinum Blue Choice Plan with Rx (Cost) include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with a $200 copay per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, are not covered.
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 are partially covered, with individual and group sessions not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Platinum Blue Choice Plan with Rx (Cost), with a $15 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Platinum Blue Choice Plan with Rx (Cost). Ground and Air Ambulance Services have a $100 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Transportation are covered under the Platinum Blue Choice Plan with Rx (Cost). Emergency Services have a $100 copay and no coinsurance, while Urgently Needed Services have a $15 copay and no coinsurance. Worldwide Emergency Coverage has a $100 copay and no coinsurance, but Worldwide Urgent Coverage is not covered.
Primary Care See details
Primary Care benefits under the Platinum Blue Choice Plan with Rx (Cost) include coverage for Chiropractic Services with a $15 copay, Occupational Therapy Services with a $15 copay, Physician Specialist Services with a $15 copay, other health care professionals with a $15 copay, Physical Therapy and Speech-Language Pathology Services with a $15 copay, and Opioid Treatment Program Services with a $15 copay. Routine Chiropractic Care, Individual and Group Sessions for Mental Health and Psychiatric Services, Podiatry Services, and Additional Telehealth Benefits are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, health education, fitness benefits (memory fitness), remote access technologies, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. In-home safety assessment, personal emergency response system (PERS), medical nutrition therapy (MNT), post discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids with no deductible, and prescription hearing aids. Routine hearing exams are covered for two visits every year, and fitting/evaluation for hearing aids has no limit. Prescription hearing aids have a copay between $599 and $899 for two hearing aids every year, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Platinum Blue Choice Plan with Rx (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 with Rx (Cost) covers dental services with a $2,000 maximum benefit per year, including a $15 copay for Medicare dental services. Oral exams, dental x-rays, cleanings, fluoride treatments, and adjunctive general services are covered, but restorative services, endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Platinum Blue Choice Plan with Rx (Cost). Medicare Part B Insulin Drugs have a copay between $0 and $35, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Platinum Blue Choice Plan with Rx (Cost), with a copay of $15.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20-40% coinsurance and Prosthetic Devices and Medical Supplies with a 20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Platinum Blue Choice Plan with Rx (Cost), but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered, and there is no copay.
Home Health Services See details
Home Health Services are covered by the Platinum Blue Choice 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 technically covered, but not in practice, as Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Platinum Blue Choice Plan with Rx (Cost) with no copay for days 1-20 and no 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
Other Services include acupuncture, with a $15 copay, and over-the-counter (OTC) items with a $50 maximum benefit every three months, including nicotine replacement therapy and naloxone coverage. Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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