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BlueMedicare Preferred (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueMedicare Preferred (PFFS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueMedicare Preferred (PFFS) in 2026, please refer to our full plan details page.
BlueMedicare Preferred (PFFS) is a PFFS 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 3.5 out of 5 stars in 2026.
It's important to know that BlueMedicare Preferred (PFFS) 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 Preferred (PFFS).
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 Preferred (PFFS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.00. 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 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 combined Maximum Out-Of-Pocket cost of $7500.00 (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 $7500.00 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:
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Drug Coverage
The BlueMedicare Preferred (PFFS) plan offers a Basic Alternative prescription drug benefit with an annual deductible of $615.00. The standard Part D premium is $58.00, which reduces to $49.10 for individuals who qualify for full Low-Income Subsidy (LIS) assistance. During the initial coverage phase at standard pharmacies, you will pay a $12.00 copay for Tier 1 preferred generics, 20% coinsurance for Tier 2 standard generics, 30% coinsurance for Tier 3 preferred brands, and 25% coinsurance for Tier 4 non-preferred drugs. These initial coverage rates apply until your total yearly drug costs reach $2,100.00. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D drugs.
Additional Benefits
The BlueMedicare Preferred (PFFS) plan offers comprehensive coverage for essential medical needs with predictable cost-sharing, including a $10 copay for primary care visits and no copay for telehealth or home health services. Inpatient hospital stays require a $390 copay for days 1 through 5 followed by no copay for days 6 through 90, while outpatient hospital services require a $340 copay. Emergency services and urgent care are also covered with a $115 copay and $40 copay, respectively, with no coinsurance required for either. Routine preventive services, annual physicals, routine eye exams, and preventive dental cleanings up to a $3,000 annual limit are all available with no copay or coinsurance. For specialized care, members pay a 20% coinsurance and no copay for dialysis, medical equipment, and diabetic shoes. Additionally, the plan includes a $25 quarterly allowance for over-the-counter items with no copay or coinsurance to help support your daily wellness.
Inpatient Hospital See details
BlueMedicare Preferred (PFFS) partially covers inpatient acute and psychiatric hospital stays with no coinsurance and a copay of $390 for days 1 to 5, followed by no copay for days 6 to 90. However, additional days, non-Medicare-covered stays, and acute care upgrades are not covered.
Outpatient Services See details
BlueMedicare Preferred (PFFS) covers outpatient services with no coinsurance, including outpatient hospital, observation, and ambulatory surgical center services for a $340 copay. Outpatient substance abuse sessions require a $40 copay, while outpatient blood services are covered with no copay.
Partial Hospitalization See details
BlueMedicare Preferred (PFFS) covers partial hospitalization benefits with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by BlueMedicare Preferred (PFFS), as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require a $325 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
BlueMedicare Preferred (PFFS) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency services are partially covered up to a $15,000 lifetime maximum with a 20% coinsurance and no copay for emergency and urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Preferred (PFFS) provides partially covered Primary Care benefits with no coinsurance, featuring copays ranging from $10 for primary care visits to $40 for specialists, and no copay for telehealth. However, podiatry services and routine chiropractic care are not covered.
Preventive Services See details
BlueMedicare Preferred (PFFS) partially covers preventive services, offering covered benefits like annual physical exams, fitness benefits, and kidney disease education with no copay and no coinsurance. However, several sub-services are not covered, including Medicare-covered zero-dollar preventive services, health education, weight management programs, and personal emergency response systems.
Hearing Services See details
BlueMedicare Preferred (PFFS) provides partially covered hearing services with no coinsurance or deductibles. Routine hearing exams and fitting evaluations have no copay, Medicare-covered exams require a $35 copay, and up to two prescription hearing aids are covered annually with a $699 to $999 copay. OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by BlueMedicare Preferred (PFFS) with copays ranging from no copay to $40, no coinsurance, and no deductible, though eyeglass lenses and eyeglass frames are not covered. Covered benefits include one annual routine eye exam with no copay and up to $100 annually for eyewear such as contact lenses and eyeglasses.
Dental Services See details
BlueMedicare Preferred (PFFS) partially covers dental services, offering Medicare-covered dental for a $40 copay with no coinsurance, and preventive care like exams and cleanings with no copay or coinsurance up to a $3,000 annual limit. Covered comprehensive services require a 20% coinsurance with no copay, while fluoride treatment, adjunctive general services, endodontics, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by BlueMedicare Preferred (PFFS), featuring a $35 copay and no coinsurance for Medicare Part B insulin drugs. Covered Part B chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered under the BlueMedicare Preferred (PFFS) plan with a 20% coinsurance and no copay. This benefit helps you manage the costs of essential dialysis treatments with clear, predictable cost-sharing.
Medical Equipment See details
Medical equipment benefits are covered by BlueMedicare Preferred (PFFS), including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts, which all require a 20% coinsurance and no copay. Diabetic supplies are also covered with no copay.
Diagnostic and Radiological Services See details
BlueMedicare Preferred (PFFS) covers diagnostic and radiological services. Diagnostic tests, procedures, and lab services require no copay and 0% to 20% coinsurance, while diagnostic radiological services carry a $25 to $340 copay and no coinsurance. Therapeutic radiological and outpatient X-ray services require 20% coinsurance and no copay.
Home Health Services See details
Home Health Services are covered by BlueMedicare Preferred (PFFS) with no copay and no coinsurance required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by BlueMedicare Preferred (PFFS) where some services are covered, but in practice, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered. Because these specific services are not covered, there are no active copays or coinsurance rates available for them.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered under BlueMedicare Preferred (PFFS), as additional days beyond Medicare-covered care are not covered. Patients pay no copay and no coinsurance for days 1 through 20, and a $218 daily copay with no coinsurance for days 21 through 100.
Other Services See details
Other Services are partially covered under BlueMedicare Preferred (PFFS), featuring Over-the-Counter (OTC) items with no copay and no coinsurance up to a $25 maximum benefit every three months. Acupuncture, meal benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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