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.

This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.

BlueMedicare Preferred (PFFS) is a PFFS plan offered by Usable Mutual Insurance Company available for the 2026 plan year 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.

Overview IconKey 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 $48.00. 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

Health deductible: information not available.

This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.

Out-of-Pocket Maximums

This plan has a Maximum Out-Of-Pocket cost of $7500.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $7500.00 for covered services, the plan will pay 100% of 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:

Regular visits to your primary care doctor are covered and will have a coinsurance of 0% (no coinsurance).

Specialist Visits:

Visits to specialists are covered and will have a coinsurance of 0% (no coinsurance). Specialist visits may require a referral from your primary care doctor or prior authorization.

Emergency Room:

Trips to the Emergency Room are covered, and will have a coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Urgent Care:

Trips to Urgent Care are covered and will have a coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Sign up for BlueMedicare Preferred (PFFS)

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Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.

Drug Coverage IconDrug Coverage

The BlueMedicare Preferred (PFFS) plan features a prescription drug deductible of $615.00 under its Basic Alternative drug benefit. After meeting this deductible, standard pharmacy costs during the initial coverage phase include a $12.00 copay for Tier 1 preferred generic drugs, 20% coinsurance for Tier 2 standard generics, 30% coinsurance for Tier 3 preferred brands, and 25% coinsurance for Tier 4 non-preferred drugs. 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. Individuals who qualify for the low-income subsidy can also see their Part D premium reduced from $48.00 to $39.10.

Additional Benefits IconAdditional Benefits

The BlueMedicare Preferred (PFFS) plan offers comprehensive coverage for essential medical needs, featuring no copay for primary care telehealth visits, preventive screenings, and routine home health services. For in-person care, members can expect a $10 copay for primary care visits, a $40 copay for specialist visits, and a $390 daily copay for the first five days of inpatient hospital stays. Emergency care requires a $115 copay, while ground ambulance services are covered with a $325 copay and no coinsurance. This plan also includes valuable supplemental benefits, such as routine dental exams, cleanings, and routine eye exams with no copay or coinsurance. Hearing care features no copay for routine exams, with prescription hearing aids available for copays ranging from $699 to $999. Additionally, members receive a $25 quarterly allowance for over-the-counter items with no copay, alongside a 20% coinsurance for durable medical equipment and dialysis services.

Inpatient Hospital See details

Inpatient hospital benefits are covered by BlueMedicare Preferred (PFFS) with a $390 daily copay for days 1 through 5, no copay for days 6 through 90, and no coinsurance for acute and psychiatric stays. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.

Outpatient Services See details

BlueMedicare Preferred (PFFS) covers outpatient hospital, observation, and ambulatory surgical center services with a $340 copay and no coinsurance. Outpatient substance abuse services require a $40 copay and no coinsurance, while outpatient blood services are covered with no copay, no deductible, and no coinsurance.

Partial Hospitalization See details

BlueMedicare Preferred (PFFS) covers partial hospitalization benefits with a copay of $55.00 and no coinsurance.

Ambulance and Transportation Services See details

Ambulance and transportation services are partially covered under BlueMedicare Preferred (PFFS), as transportation services to health-related locations are not 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 limit 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) partially covers Primary Care benefits with no coinsurance, offering primary care visits for a $10 copay, specialist visits for a $40 copay, and telehealth services with no copay. Other covered services, such as physical therapy and mental health sessions, carry a $35 copay, while podiatry services and routine chiropractic care are not covered.

Preventive Services See details

Preventive services are partially covered by BlueMedicare Preferred (PFFS), which offers annual physical exams, fitness benefits, and select screenings with no copay and no coinsurance. However, Medicare-covered zero-dollar preventive services, health education, weight management, and in-home safety assessments are not covered.

Hearing Services See details

BlueMedicare Preferred (PFFS) partially covers hearing services, providing routine hearing exams and fitting evaluations with no copay and no coinsurance, and Medicare-covered exams for a $35 copay and no coinsurance. Up to two prescription hearing aids (all types) are covered annually with a copay of $699 to $999 and no coinsurance, while OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.

Vision Services See details

BlueMedicare Preferred (PFFS) offers partially covered vision services, as eyeglass lenses and eyeglass frames are not covered. Routine eye exams, contact lenses, eyeglasses (lenses and frames), and upgrades feature no copay and no coinsurance, while other eye exams have a copay of up to $40 and eyewear has a $40 copay with no coinsurance up to a $100 annual limit.

Dental Services See details

BlueMedicare Preferred (PFFS) dental services are partially covered up to a $3,000 annual limit, with no copay or coinsurance for exams, cleanings, and x-rays, a $40 copay and no coinsurance for Medicare dental, and a 20% coinsurance with no copay for restorative, periodontic, removable prosthodontic, and oral surgery services. Fluoride treatments, adjunctive general services, endodontics, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.

Home Infusion bundled Services See details

Home infusion bundled services are covered by BlueMedicare Preferred (PFFS), which offers Medicare Part B insulin drugs for a $35 copay and no coinsurance. Other covered Part B drugs, including chemotherapy and radiation, require no copay and have coinsurance ranging from no coinsurance up to 20%.

Dialysis Services See details

BlueMedicare Preferred (PFFS) covers Dialysis Services with 20% coinsurance and no copay.

Medical Equipment See details

BlueMedicare Preferred (PFFS) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, with a 20% coinsurance and no copay. Diabetic supplies are covered with no copay and no coinsurance.

Diagnostic and Radiological Services See details

BlueMedicare Preferred (PFFS) covers diagnostic and radiological services, with diagnostic tests and lab services requiring no copay and 0% to 20% coinsurance. Radiological services carry either a 20% coinsurance for therapeutic and X-ray services, or a copay ranging from $25 to $340 for diagnostic radiological services.

Home Health Services See details

BlueMedicare Preferred (PFFS) covers Home Health Services with no copay and no coinsurance.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are not covered under BlueMedicare Preferred (PFFS). None of the associated sub-services, including intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services, are covered by this plan.

Skilled Nursing Facility (SNF) See details

BlueMedicare Preferred (PFFS) partially covers Skilled Nursing Facility (SNF) services, offering no copay and no coinsurance for days 1 to 20, and a $218 daily copay with no coinsurance for days 21 to 100. Additional days beyond the Medicare-covered limit are not covered by the plan.

Other Services See details

BlueMedicare Preferred (PFFS) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $25 every three months. Acupuncture, meal benefits, and dual eligible SNPs are not covered under this plan.

Plan Providers IconPlan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.

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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.

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