A non-government entity
BlueMedicare Premier Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueMedicare Premier Choice (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueMedicare Premier Choice (PPO) in 2025, please refer to our full plan details page.
BlueMedicare Premier Choice (PPO) is a PPO plan offered by USAble Mutual Insurance Company available for enrollment in 2025 to people living in Select Counties in Arkansas. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that BlueMedicare Premier Choice (PPO) 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 BlueMedicare Premier Choice (PPO).
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 BlueMedicare Premier Choice (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.00. 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.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $9550.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9550.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 BlueMedicare Premier Choice (PPO)
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 BlueMedicare Premier Choice (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, standard generic drugs have a $10 copay, while preferred brand drugs have a 50% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your Part D premium is $15.30.
Additional Benefits
The BlueMedicare Premier Choice (PPO) plan offers a wide range of benefits with varying costs. Hospital stays have a copay for the first few days, but no copay after that. Outpatient services, including primary care, have copays, while some preventive services and home health services have no copay. This plan also covers vision, dental, and hearing services, with copays and coinsurance depending on the specific service. It includes coverage for emergency services, ambulance services, and medical equipment. The plan also offers additional benefits such as over-the-counter items and a meal benefit with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5, there is a $375 copay, and for days 6-90, there is no copay. Additional days and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $325 copay, observation services with a $325 copay and prior authorization required, and ambulatory surgical center services with a $250 copay. Outpatient substance abuse services have a $40 copay for both individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueMedicare Premier Choice (PPO) plan, with a copay of $85.00. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $325 copay for ground ambulance services and 20% coinsurance for air ambulance services. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the BlueMedicare Premier Choice (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a 20% coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueMedicare Premier Choice (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $40 copay, physician specialist services with a $35 copay, and mental health specialty services with a $35 copay for individual and group sessions. The plan also covers podiatry services with a $30 copay, other health care professional services with a copay between $0 and $35, and psychiatric services with a $35 copay for individual and group sessions. Additionally, it covers physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $50 copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services including fitness and remote access technologies with no copay. Other services such as health education, in-home safety assessment, and others are not covered.
Hearing Services See details
The BlueMedicare Premier Choice (PPO) plan covers hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1500 every three years, and all types of prescription hearing aids have no copay, however, inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay between $0 and $35, and eyewear. Eyewear includes contact lenses, eyeglasses (lenses and frames), and upgrades with no copay, but has a combined maximum plan benefit of $250 per year for both in-network and out-of-network services. However, eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $35 copay, and other dental services, including oral exams with no copay for up to 2 visits per year, dental x-rays with no copay, prophylaxis (cleaning) with no copay for up to 2 visits per year, and fluoride treatments with no copay. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), and Oral and Maxillofacial Surgery are covered with 20% coinsurance, while Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered. The plan has a maximum benefit of $3,000 per year for in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the BlueMedicare Premier Choice (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, as well as Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the BlueMedicare Premier Choice (PPO) plan, with some services requiring prior authorization. Diagnostic Procedures/Tests have a copay between $0.00 and $100.00, and Lab Services have a coinsurance of at most 20%. Diagnostic Radiological Services have a copay of at most $325.00, and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the BlueMedicare Premier Choice (PPO) plan 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 covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The BlueMedicare Premier Choice (PPO) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum plan benefit coverage amount of $50 every three months. The plan also covers a Meal Benefit with no copay, but Acupuncture, 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.
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