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Blue adVantage Platinum (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue adVantage Platinum (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 Platinum (HMO-POS) in 2026, please refer to our full plan details page.
Blue adVantage Platinum (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 4 out of 5 stars in 2026.
It's important to know that Blue adVantage Platinum (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 Platinum (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 Platinum (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $218.00. 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 $300.00 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 Maximum Out-Of-Pocket cost of $3500.00 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 Platinum (HMO-POS) prescription drug plan features a $300 annual deductible. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service, compared to a $5 copay at standard pharmacies for a one-month supply. Tier 2 generic drugs carry a $12 copay at preferred locations and a $14 copay at standard locations. Tier 3 preferred brand drugs require a $45 copay at preferred pharmacies and a $47 copay at standard pharmacies for a one-month supply. For higher-tier medications, Tier 4 non-preferred drugs carry a 50% coinsurance, while Tier 5 specialty drugs require a 29% coinsurance across both preferred and standard pharmacy options.
Additional Benefits
The Blue adVantage Platinum (HMO-POS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care doctor visits, annual physicals, and home health services. For specialist visits, you will pay a copay ranging from $15 to $25 with no coinsurance. Inpatient hospital stays require a daily copay of $205 for the first seven days and no copay for days eight through 90, with no coinsurance required. This plan also includes strong supplemental benefits, such as routine dental care with no copay and no coinsurance up to a $2,700 annual maximum. Routine vision and hearing exams are covered with no copay, which includes up to $200 annually for eyewear and up to $800 every three years for prescription hearing aids. Emergency room visits require a $125 copay, which is waived if you are admitted to the hospital within 72 hours.
Inpatient Hospital See details
Blue adVantage Platinum (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, subject to prior authorization. Acute stays require a $205 daily copay for days 1 through 7 and no copay for days 8 through 90, whereas psychiatric stays require a $225 daily copay for days 1 through 7 and no copay for days 8 through 90. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Blue adVantage Platinum (HMO-POS) covers outpatient hospital services with a $0 to $150 copay, observation services with a $205 daily copay, and ambulatory surgical center services with no copay, all with no coinsurance. Outpatient substance abuse sessions carry a $10 to $20 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Blue adVantage Platinum (HMO-POS) with a $60.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Blue adVantage Platinum (HMO-POS) covers ambulance services with no coinsurance, requiring a $250 copay for ground ambulance and a $260 copay for air ambulance services. For transportation services, some services are covered but transportation to plan-approved or any other health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Blue adVantage Platinum (HMO-POS) with a $125 copay, which is waived if admitted to the hospital within 72 hours, and no coinsurance, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency coverage is also available with a $125 copay and no coinsurance, though worldwide urgent care and worldwide emergency transportation are not covered.
Primary Care See details
Primary care benefits under Blue adVantage Platinum (HMO-POS) feature no copay and no coinsurance for primary care doctor visits, and a $15 to $25 copay with no coinsurance for specialists. Outpatient therapies and mental health services are covered with copays ranging from $10 to $35 and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Blue adVantage Platinum (HMO-POS) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. However, this benefit is only partially covered, as supplemental services like health education, in-home safety assessments, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Hearing services are covered by Blue adVantage Platinum (HMO-POS) with no copay and no coinsurance, which includes one routine hearing exam annually and unlimited fittings. While OTC hearing aids are covered, prescription hearing aids are only partially covered up to an $800 maximum every three years, with inner ear, outer ear, and over-the-ear models not covered.
Vision Services See details
Blue adVantage Platinum (HMO-POS) vision services are partially covered with no deductible, offering routine eye exams with no copay and other exams with a $15.00 to $25.00 copay, both with no coinsurance. Eyewear is covered with no copay and no coinsurance up to a $200 annual maximum, though other eye exam services are not covered.
Dental Services See details
Blue adVantage Platinum (HMO-POS) offers partially covered dental services with no copay and no coinsurance up to a maximum annual benefit of $2,700. Sub-services that are not covered under this plan include other preventive dental services, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
Blue adVantage Platinum (HMO-POS) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs have a coinsurance ranging from no coinsurance up to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Blue adVantage Platinum (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Blue adVantage Platinum (HMO-POS) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance. Diabetic equipment is also covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered under this plan.
Diagnostic and Radiological Services See details
Blue adVantage Platinum (HMO-POS) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay and no coinsurance. Diagnostic tests carry a $0 to $30 copay with no coinsurance, while therapeutic radiological services require a minimum 20% coinsurance and an applicable copay.
Home Health Services See details
Blue adVantage Platinum (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Blue adVantage Platinum (HMO-POS) covers Cardiac Rehabilitation Services with no coinsurance, though only some services are covered in practice. Standard cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($10 copay) are not covered and require prior authorization.
Skilled Nursing Facility (SNF) See details
Blue adVantage Platinum (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization and a 3-day inpatient hospital stay are required. There is no copay for days 1 through 20, followed by a $200 daily copay for days 21 through 100, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Blue adVantage Platinum (HMO-POS) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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