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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 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 $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
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:
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Drug Coverage
The BlueMedicare Preferred (PFFS) plan has a $490 deductible for prescription drugs. After the deductible, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $15 copay for a preferred generic drug at a standard or mail-order pharmacy. You will pay 20% coinsurance for a standard generic drug at a standard or mail-order pharmacy.
Additional Benefits
The BlueMedicare Preferred (PFFS) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay for the first few days, while outpatient services, including emergency care, have copays. Primary care visits have a $20 copay, and many preventive services are covered with no copay. This plan covers hearing and vision services, with copays for exams and hearing aids. Dental services include coverage for oral exams and cleanings with no copay, and restorative services with coinsurance. Home health services, skilled nursing facilities, and durable medical equipment are also covered, with varying cost-sharing.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the BlueMedicare Preferred (PFFS) plan, with a copay of $390 for days 1-5, and no copay for days 6-90 for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. 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, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, are covered by the BlueMedicare Preferred (PFFS) plan. Outpatient hospital services, observation services, and ambulatory surgical center services have a $340 copay, while individual and group outpatient substance abuse sessions have a copay between $40 and $40. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueMedicare Preferred (PFFS) plan with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with ground ambulance services costing a $325 copay, and air ambulance services costing 20% coinsurance. Transportation services to health-related locations 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, and Urgently Needed Services have a $45 copay. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a 20% coinsurance, while 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, individual and group mental health and psychiatric sessions with a $35 copay, physical therapy and speech-language pathology services with a $35 copay, and opioid treatment program services with a $50 copay. Additional telehealth benefits have no copay.
Preventive Services See details
The BlueMedicare Preferred (PFFS) plan covers preventive services, including an annual physical exam with no copay, and additional preventive services with a copay for Fitness Benefit and Remote Access Technologies. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. However, Medicare-covered Zero Dollar Preventive Services, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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
The BlueMedicare Preferred (PFFS) plan covers hearing exams with a $50 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $699 and $999, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services are covered under the BlueMedicare Preferred (PFFS) plan. Eye exams have a copay of $0-$50, while eyewear has a $50 copay; however, routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $50 copay, as well as Oral Exams and Dental X-Rays with no copay, and Prophylaxis (Cleaning) with no copay. Restorative Services, Periodontics, Prosthodontics (removable), and Oral and Maxillofacial Surgery are covered with a 20% coinsurance, while Fluoride Treatment, Adjunctive General Services, Endodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered. This plan has a maximum benefit coverage of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the BlueMedicare Preferred (PFFS) plan, 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.
Dialysis Services See details
Dialysis Services are covered under the BlueMedicare Preferred (PFFS) plan. There is a coinsurance of 20% for this benefit.
Medical Equipment See details
Medical Equipment is covered under the BlueMedicare Preferred (PFFS) plan. Durable Medical Equipment (DME) has a 20% coinsurance, with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, with no copay, while Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for all diagnostic services. Diagnostic Procedures/Tests and Lab Services have a coinsurance of up to 20%, while Diagnostic Radiological Services have a copay of up to $340, with a minimum copay of $25. Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of up to 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 the BlueMedicare Preferred (PFFS) plan, but no specific sub-services are covered. There is a copay for some services, but the details of the copay are not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueMedicare Preferred (PFFS) plan. There is no copay for days 1-20, and a $203 copay for days 21-100, with no coinsurance.
Other Services See details
Other services are generally covered by the BlueMedicare Preferred (PFFS) plan, but acupuncture, over-the-counter items, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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