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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 $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 $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 a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $15 copay for preferred generic drugs at a standard or mail-order pharmacy. For standard generic drugs, you will pay 20% coinsurance, and for preferred brand drugs, you will pay 32% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The BlueMedicare Preferred (PFFS) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays for services like outpatient hospital and substance abuse. Emergency and primary care services are covered, with copays for services like emergency room visits and specialist visits. Preventive services like annual physical exams have no copay, and hearing exams have a copay. Vision services include eye exams and eyewear with copays, and dental services have a $3,000 annual maximum benefit. The plan also covers home health services with no copay, and skilled nursing facility stays have a copay after the first 20 days.
Inpatient Hospital See details
Inpatient Hospital coverage under the BlueMedicare Preferred (PFFS) plan includes 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 Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the BlueMedicare Preferred (PFFS) plan. Outpatient Hospital Services, Observation Services, and Ambulatory Surgical Center (ASC) Services each have a $340 copay. Outpatient Substance Abuse services have a $40 copay for both individual and group sessions, and there is no copay for Outpatient Blood Services.
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 under the BlueMedicare Preferred (PFFS) plan. Ground Ambulance Services have a $325 copay, while Air Ambulance Services have a 20% coinsurance; however, 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, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage has 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, and specialist services with a $50 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $35 or $50 copay depending on the service, and physical therapy/speech-language pathology services have a $35 copay. Additional telehealth benefits are covered with no copay. 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 Benefits, Remote Access Technologies, Kidney Disease Education Services, and Other Preventive Services with no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. 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 for 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 also not covered.
Vision Services See details
Vision services are covered, including eye exams with a copay ranging from $0 to $50 and eyewear with a $50 copay, but routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered. There is no coinsurance or deductible for these services.
Dental Services See details
The BlueMedicare Preferred (PFFS) plan offers dental services with a $3,000 maximum benefit per year. Medicare dental services have a $50 copay, while oral exams and dental x-rays have no copay. Other dental services like fluoride treatment, adjunctive general services, endodontics, maxillofacial prosthetics, implant services, prosthodontics fixed, and orthodontics are not covered. Restorative services, periodontics, prosthodontics removable, and oral and maxillofacial surgery have a 20% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the BlueMedicare Preferred (PFFS) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a 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
The BlueMedicare Preferred (PFFS) plan covers Durable Medical Equipment (DME) with a 20% coinsurance, but does not cover DME for use outside the home. Prosthetic Devices and Medical Supplies are covered with a 20% coinsurance, 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, including Diagnostic Procedures/Tests and Lab Services with a coinsurance of at most 20%, and Diagnostic Radiological Services with a copay of at most $340.00 and a minimum copayment of $25.00. 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 the BlueMedicare Preferred (PFFS) plan, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The plan does not specify the cost sharing, such as copay or coinsurance.
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, but there is a $203 copay for days 21-100; 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, including acupuncture, over-the-counter items, meal benefits, and dual eligible SNPs with highly integrated services.
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