A non-government entity
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 2025, 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 2025.
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 $38.00. 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 $490.00 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:
Sign up for BlueMedicare Preferred (PFFS)
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 Preferred (PFFS) plan has a $490 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, for preferred generic drugs you will pay a $15 copay at standard and mail order pharmacies. For standard generic drugs you will pay 20% coinsurance.
Additional Benefits
The BlueMedicare Preferred (PFFS) plan offers a range of benefits, including inpatient hospital stays with a $390 copay for days 1-5 and no copay for days 6-90, as well as outpatient services with various copays depending on the service. Primary care visits have a $20 copay, and preventive services, such as an annual physical exam, have no copay. Additional coverage includes ambulance services with a $325 copay for ground transport and 20% coinsurance for air, along with hearing services that include hearing exams with a $50 copay and prescription hearing aids with a copay between $699 and $999. The plan also covers dental services with a $50 copay for Medicare Dental Services and offers home health services with no copay, but does not cover vision services or other services such as acupuncture.
Inpatient Hospital See details
Inpatient Hospital benefits for BlueMedicare Preferred (PFFS) include coverage for both acute and psychiatric hospital stays. For days 1-5, the copay is $390, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services are covered by the BlueMedicare Preferred (PFFS) plan, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, and ambulatory surgical center services have a $340 copay, while individual and group outpatient substance abuse sessions have a $40 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueMedicare Preferred (PFFS) plan, with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueMedicare Preferred (PFFS) plan, with ground ambulance services costing a $325 copay and air ambulance services incurring a 20% coinsurance. 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 under the BlueMedicare Preferred (PFFS) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 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 Preferred (PFFS) plan covers primary care physician services with a $20 copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $50 copay, and mental health specialty services with a $35 copay for individual and group sessions. The plan also covers physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $50 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The BlueMedicare Preferred (PFFS) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services, including Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, and Other Preventive Services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $50 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a copay between $699 and $999. OTC hearing aids are not covered, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services are covered by the BlueMedicare Preferred (PFFS) plan, but routine eye exams and eyewear are not covered. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered by the BlueMedicare Preferred (PFFS) plan, with a $50 copay for Medicare Dental Services. Other dental services include oral exams and dental x-rays with no copay, prophylaxis (cleaning) with no copay, restorative services with 20% coinsurance, periodontics with 20% coinsurance, prosthodontics, removable with 20% coinsurance, and oral and maxillofacial surgery with 20% coinsurance; however, fluoride treatment, adjunctive general services, endodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. There is a $3,000 annual maximum benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the BlueMedicare Preferred (PFFS) plan, including Medicare Part B Insulin Drugs for a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the BlueMedicare Preferred (PFFS) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies and Diabetic Equipment, is covered under the BlueMedicare Preferred (PFFS) plan. Durable Medical Equipment has a 20% coinsurance, and Prosthetic Devices and Medical Supplies also have a 20% coinsurance, but Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, Diagnostic Radiological Services have a copay of at most $340, and Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the BlueMedicare Preferred (PFFS) 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 by BlueMedicare Preferred (PFFS), but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueMedicare Preferred (PFFS) plan. For days 1-20, there is no copay, and for days 21-100, there is a $203 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered by the BlueMedicare Preferred (PFFS) plan. Acupuncture, Over-the-Counter (OTC) Items, Meal Benefit, and Dual Eligible SNPs with Highly Integrated 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