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Blue adVantage Classic (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue adVantage Classic (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue adVantage Classic (HMO-POS) in 2025, please refer to our full plan details page.
Blue adVantage Classic (HMO-POS) is a HMO-POS plan offered by Louisiana Health Service & Indemnity Company available for enrollment in 2025 to people living in State of Louisiana. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Blue adVantage Classic (HMO-POS) 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 Blue adVantage Classic (HMO-POS).
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 Blue adVantage Classic (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.10. You must continue to pay paying your reduced 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network 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:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Blue adVantage Classic (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for generic drugs, and coinsurance for brand-name and non-preferred drugs. The copays and coinsurance amounts vary depending on the drug tier and whether you use a preferred or standard pharmacy. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Blue adVantage Classic (HMO-POS) plan offers a range of benefits with varying cost-sharing. For inpatient hospital stays, you'll pay a copay, while outpatient services have copays ranging from $0 to $350. Emergency services and primary care visits have copays, and many other services like hearing, vision, and dental have no copay. The plan also covers prescription hearing aids up to $800 per year and eyewear up to $400 per year. Other benefits include home health services with no copay, and skilled nursing facility care with a copay after 20 days. Some services, like ambulance, require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $245 copay for days 1-10, and no copay for days 11-90; for Inpatient Hospital Psychiatric, you will pay a $225 copay for days 1-8, and no copay for days 9-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $350, observation services with a $245 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue adVantage Classic (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $60.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue adVantage Classic (HMO-POS) plan, with prior authorization required for all ambulance services. Ground Ambulance Services have a $250 copay, while Air Ambulance Services have a $260 copay, and Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Blue adVantage Classic (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $40 copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Blue adVantage Classic (HMO-POS) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while routine chiropractic care is not covered. Occupational therapy services have a $35 copay, and physician specialist services have a $30 copay. Mental health specialty services, including individual and group sessions, have a $40 copay. Other health care professional services have a copay between $0 and $30, and a 20% coinsurance. Psychiatric services, including individual and group sessions, have a $40 copay. Physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a copay between $0 and $40. Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
The Blue adVantage Classic (HMO-POS) plan covers preventive services including Medicare-covered preventive services, annual physical exams, kidney disease education services, and other preventive services. Additional preventive services are not covered, including health education, in-home safety assessments, and more. The plan also covers home-based palliative care and fitness benefits.
Hearing Services See details
Hearing Services include coverage for hearing exams with no copay, routine hearing exams with no copay for one visit every year, and fitting/evaluation for hearing aids with no copay for one visit every year. Prescription hearing aids are covered, with a maximum plan benefit coverage of $800 per year, and OTC hearing aids are covered with no copay.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a $30 copay, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, but are limited to a combined maximum of $400 per year.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), implant services, prosthodontics (fixed), and oral and maxillofacial surgery, all with no copay. Maxillofacial prosthetics and orthodontics are not covered. Other dental services have a maximum plan benefit coverage of $2,200 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Blue adVantage Classic (HMO-POS) plan, but require prior authorization. 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 Blue adVantage Classic (HMO-POS) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment is covered by the Blue adVantage Classic (HMO-POS) plan. Durable Medical Equipment (DME) has a 20% coinsurance, with no copay, and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit, and Prosthetic Devices have a 20% coinsurance, with no copay. Medical Supplies have a 20% coinsurance, with no copay. Diabetic Equipment is covered with prior authorization, but Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay for some services and coinsurance for others. Diagnostic Procedures/Tests have a copay between $0 and $30, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $250, and Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance up to 20%.
Home Health Services See details
Home Health Services are covered by the Blue adVantage Classic (HMO-POS) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue adVantage Classic (HMO-POS). There is no copay for days 1-20, and the copay is $165 per day for days 21-100.
Other Services See details
The Blue adVantage Classic (HMO-POS) plan's "Other Services" benefit covers over-the-counter items, but does not cover acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. Over-the-counter items are covered, but the plan does not cover all drugs on the CMS OTC list.
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