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Platinum Blue Complete Plan with Rx (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Platinum Blue Complete 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 Complete Plan with Rx (Cost) in 2025, please refer to our full plan details page.
Platinum Blue Complete 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 Complete 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 Complete 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 Complete Plan with Rx (Cost), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $282.20. 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 $2700.00 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 Complete Plan with Rx (Cost) has a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $2 copay at preferred and mail order pharmacies, and a $7 copay at standard pharmacies. For standard generic drugs, you pay 25% coinsurance. Preferred brand drugs have 40% coinsurance at preferred pharmacies, and 42% coinsurance at standard pharmacies. Once your total yearly drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Platinum Blue Complete Plan with Rx (Cost) provides coverage for inpatient hospital stays with a $100 copay per admission, as well as outpatient services. Additionally, this plan covers ambulance services, emergency services, primary care, preventive services, hearing, vision, dental, and home health services. Many services have no copay, including ambulance, emergency, primary care, and home health. This plan also offers additional benefits such as hearing exams, prescription hearing aids with a copay, and a yearly allowance for eyewear. It also includes a $2,000 annual maximum for dental services, and covers home infusion services, dialysis services, and medical equipment. However, it is important to note that some services, like diagnostic and radiological services, and cardiac rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is a $100 copay per admission or stay. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient substance abuse services are partially covered, as individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization benefits are covered by the plan. There is no information about the cost of the benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Platinum Blue Complete Plan with Rx (Cost), but ground ambulance, air ambulance, and transportation services to any health-related location are not covered. All covered services have no copay and no coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered with no copay and no coinsurance. Worldwide Urgent Coverage is not covered. Worldwide Emergency Transportation is covered.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, and Physical Therapy and Speech-Language Pathology Services are covered with no copay and no coinsurance. Chiropractic Services, Physician Specialist Services, Other Health Care Professional, and Opioid Treatment Program Services are covered, but require prior authorization. Individual and group sessions for Mental Health and Psychiatric Services, Podiatry Services, and Additional Telehealth Benefits are not covered.
Preventive Services See details
The Platinum Blue Complete Plan with Rx (Cost) covers preventive services, including Medicare-covered services, annual physical exams, health education, fitness benefits, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. However, 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, including routine hearing exams and fitting/evaluation for hearing aids, are covered by the Platinum Blue Complete Plan with Rx (Cost). Routine hearing exams are limited to 2 per year, and fitting/evaluation for hearing aids is unlimited. Prescription hearing aids (all types) are covered with a copay between $499 and $799 per year, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Platinum Blue Complete Plan with Rx (Cost) covers routine eye exams once per year with no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered with a 20% coinsurance for contact lenses, and a combined maximum of $150 per year.
Dental Services See details
The Platinum Blue Complete Plan with Rx (Cost) covers a maximum of $2,000 per year for dental services, including oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and adjunctive general services. 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, with prior authorization required. Medicare Part B Insulin Drugs have a copay between $0 and $35, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Platinum Blue Complete Plan with Rx (Cost). There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits under the Platinum Blue Complete Plan with Rx (Cost) include Durable Medical Equipment (DME), which has a coinsurance between 0% and 20% and requires authorization, but does not have a copay. The plan does not cover Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, or Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are not covered by the Platinum Blue Complete Plan with Rx (Cost), as all sub-services are not covered. There is no copay for these services.
Home Health Services See details
Home Health Services are covered by the Platinum Blue Complete Plan with Rx (Cost) with no copay and no coinsurance, but 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; 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 Complete Plan with Rx (Cost) with 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 "Other Services", the Platinum Blue Complete Plan with Rx (Cost) covers acupuncture with prior authorization, up to 12 treatments per year, and over-the-counter (OTC) items with a maximum benefit of $50 every three months, including nicotine replacement therapy and naloxone. 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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