BlueMedicare Patriot (PPO)

Inpatient Hospital See details

Inpatient Hospital benefits for the BlueMedicare Patriot (PPO) plan include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-4, and no copay for days 5-90, while Inpatient Hospital Psychiatric has a $318 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $300, Observation Services with a $125 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $20 copay for both individual and group sessions, and Outpatient Blood Services with no copay. This plan also waives the deductible for three pints of blood.

Partial Hospitalization See details

Partial Hospitalization is covered by the BlueMedicare Patriot (PPO) plan, with a $20 copay. Prior authorization is required for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by the BlueMedicare Patriot (PPO) plan, with a $250 copay for both ground and air ambulance services, and no 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 by the BlueMedicare Patriot (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, and Urgently Needed Services have a $30 copay, with no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.

Primary Care See details

The BlueMedicare Patriot (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $40 copay and require authorization.

Physician specialist services have a $45 copay. Mental health specialty services, including individual and group sessions, have a $20 copay and require prior authorization.

Other health care professional services have a copay between $0 and $20. Psychiatric services, including individual and group sessions, have a $20 copay and require prior authorization. Physical therapy and speech-language pathology services have a copay between $0 and $40, and require authorization. Additional telehealth benefits have a copay between $0 and $45, and require prior authorization.

Opioid treatment program services have a $20 copay and require prior authorization.

Preventive Services See details

Preventive Services are covered under the BlueMedicare Patriot (PPO) plan. Medicare-covered preventive services, kidney disease education services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, and Support for Caregivers of Enrollees have no copay. Annual Physical Exams, 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, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.

Hearing Services See details

Hearing services include hearing exams with a $45 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay, once per year. Prescription hearing aids are covered, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and neither are OTC hearing aids.

Vision Services See details

Vision services include eye exams with a copay of $0-$45, and eyewear with no copay. Eyewear has a combined maximum plan benefit coverage of $200 per year for both in-network and out-of-network services.

Dental Services See details

The BlueMedicare Patriot (PPO) plan covers Medicare Dental Services with a $45 copay, and other dental services with no copay. Oral exams and prophylaxis (cleaning) are covered, and each have a limit of two visits per year. Orthodontic Services, Prosthodontics, removable, and Oral and Maxillofacial Surgery are also covered with no copay, and have visit limits. However, Fluoride Treatment, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, and Orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with between 0% and 20% coinsurance, and Other Medicare Part B Drugs with between 0% and 20% coinsurance and no copay. Prior authorization is required.

Dialysis Services See details

Dialysis Services are covered by the BlueMedicare Patriot (PPO) plan. You will pay a 20% coinsurance for these services.

Medical Equipment See details

Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered under the BlueMedicare Patriot (PPO) plan. There is no copay for any services. Durable medical equipment has a coinsurance between 0-20%, while prosthetic devices have a 20% coinsurance, and medical supplies have no coinsurance.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $75, Lab Services with no copay, Diagnostic Radiological Services with a copay between $0 and $75, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $15 copay. Prior authorization is required for all diagnostic and radiological services.

Home Health Services See details

Home Health Services are covered by the BlueMedicare Patriot (PPO) 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, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the BlueMedicare Patriot (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100.

Other Services See details

The BlueMedicare Patriot (PPO) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $50 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.