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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 $78.00. 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 features a Basic Alternative drug benefit with a $615.00 prescription drug deductible. After meeting this deductible, you enter the initial coverage phase where standard pharmacy costs include 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. This initial phase lasts until total drug costs reach $2,100.00. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. Additionally, individuals who qualify for the low-income subsidy can see their Part D premium reduced from $63.60 to $54.70. Please consult the plan formulary to ensure your specific prescriptions are covered.
Additional Benefits
The BlueMedicare Preferred (PFFS) plan offers robust medical coverage with clear out-of-pocket costs, including a low $10 copay for primary care visits and no copay for telehealth services. Inpatient hospital stays require a $390 daily copay for the first five days, after which there is no copay for days 6 through 90. Outpatient services carry a $340 copay, while emergency room visits require a $115 copay with no coinsurance. Supplemental care is also highly accessible, featuring routine dental, vision, and hearing exams with no copay. Comprehensive dental care is covered up to a $3,000 annual limit with a 20% coinsurance, and home health services are provided with no copay. Members also benefit from a $25 quarterly allowance for over-the-counter items with no copay, though routine transportation and cardiac rehabilitation are not covered.
Inpatient Hospital See details
BlueMedicare Preferred (PFFS) partially covers inpatient hospital acute and psychiatric care, requiring a $390 daily copay for days 1 through 5 and no copay or coinsurance for days 6 through 90 per stay. 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 with no coinsurance, and 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 $55.00 copay and no coinsurance. This benefit ensures you have access to covered partial hospitalization services with clear and predictable out-of-pocket costs.
Ambulance and Transportation Services See details
BlueMedicare Preferred (PFFS) partially covers ambulance and transportation services, as transportation services to 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
Emergency services are covered by BlueMedicare Preferred (PFFS) with a $115 copay and no coinsurance, and urgently needed services are covered with a $40 copay and no coinsurance. Worldwide emergency and urgent services are partially covered with a 20% coinsurance and no copay up to a $15,000 maximum limit, but worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits are partially covered by BlueMedicare Preferred (PFFS), as podiatry services and routine chiropractic care are not covered. Covered services require copayments ranging from $10 to $40 and no coinsurance, including a $10 copay for primary care visits and no copay for additional telehealth benefits.
Preventive Services See details
BlueMedicare Preferred (PFFS) partially covers preventive services, offering covered benefits like annual physical exams, fitness programs, remote access technologies, and kidney disease education with no copays and no coinsurance. However, Medicare-covered zero-dollar preventive services and numerous supplemental benefits—including health education, weight management, nutritional therapy, and home safety assessments—are not covered.
Hearing Services See details
BlueMedicare Preferred (PFFS) partially covers hearing services, featuring routine hearing exams and fitting evaluations with no copay or coinsurance, alongside Medicare-covered exams for a $35 copay and no coinsurance. Up to two prescription hearing aids (all types) are covered annually with a $699 to $999 copay 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) provides partially covered vision services, though eyeglass lenses and eyeglass frames are not covered. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) require no copay and no coinsurance, while other eye exams have a copay of $0 to $40 and no coinsurance, with a $100 annual combined maximum benefit for eyewear.
Dental Services See details
BlueMedicare Preferred (PFFS) provides partial dental coverage up to a combined $3,000 annual limit, with a $40 copay and no coinsurance for Medicare-covered dental services. Preventive services like cleanings, exams, and x-rays are covered with no copay or coinsurance, while covered comprehensive services like restorative care and periodontics require a 20% coinsurance and no copay. Sub-services including fluoride, endodontics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueMedicare Preferred (PFFS) covers home infusion bundled services, including Medicare Part B insulin drugs for a $35 copay and no coinsurance. Medicare Part B chemotherapy, radiation, and other Part B drugs are covered with no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
BlueMedicare Preferred (PFFS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
BlueMedicare Preferred (PFFS) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes with 20% coinsurance and no copay. Diabetic supplies are also covered by the plan with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under BlueMedicare Preferred (PFFS), with diagnostic tests and lab services requiring no copay and 0% to 20% coinsurance. Outpatient X-rays and therapeutic services carry a 20% coinsurance and no copay, while diagnostic radiological services require a copay of $25 to $340 and no coinsurance.
Home Health Services See details
Home Health Services are covered under the BlueMedicare Preferred (PFFS) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services, including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD), are not covered under the BlueMedicare Preferred (PFFS) plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by BlueMedicare Preferred (PFFS), as additional days beyond the Medicare-covered limit are not covered. Covered stays require 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
BlueMedicare Preferred (PFFS) offers partially covered Other Services, providing over-the-counter (OTC) items with no copay and no coinsurance up to a $25 limit every three months. Acupuncture, meal benefits, and dual eligible SNPs are not covered.
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